Provider Demographics
NPI:1740640937
Name:HIBL, LEAH (LPC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HIBL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 W NORTH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4436
Mailing Address - Country:US
Mailing Address - Phone:920-226-7383
Mailing Address - Fax:
Practice Address - Street 1:17100 W NORTH AVE STE 300
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4436
Practice Address - Country:US
Practice Address - Phone:262-244-6178
Practice Address - Fax:262-299-3040
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI2146-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100057091Medicaid