Provider Demographics
NPI:1881494383
Name:KIBBY CHRISTIAN COUNSELING LLC
Entity type:Organization
Organization Name:KIBBY CHRISTIAN COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC,LPCC
Authorized Official - Phone:725-236-0525
Mailing Address - Street 1:11051 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-3309
Mailing Address - Country:US
Mailing Address - Phone:725-236-0525
Mailing Address - Fax:725-236-0525
Practice Address - Street 1:11051 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-3309
Practice Address - Country:US
Practice Address - Phone:725-236-0525
Practice Address - Fax:725-236-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health