Provider Demographics
NPI:1912354747
Name:BIBBY, JUSTIN TERRILL
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:TERRILL
Last Name:BIBBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 EVANGELINE ST
Mailing Address - Street 2:APT 195
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3800
Mailing Address - Country:US
Mailing Address - Phone:318-608-9588
Mailing Address - Fax:
Practice Address - Street 1:3000 EVANGELINE ST
Practice Address - Street 2:APT 195
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3800
Practice Address - Country:US
Practice Address - Phone:318-608-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor