Provider Demographics
NPI:1740942218
Name:LIBIOS, THERESA ANNETTE (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNETTE
Last Name:LIBIOS
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:PO BOX 80493
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78708-0493
Mailing Address - Country:US
Mailing Address - Phone:737-275-0087
Mailing Address - Fax:
Practice Address - Street 1:11900 HOBBY HORSE CT APT 726
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2928
Practice Address - Country:US
Practice Address - Phone:832-493-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health