Provider Demographics
NPI:1932414299
Name:LIBBEY, HEATHER PATRICIA (PHD, LP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:PATRICIA
Last Name:LIBBEY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 SELBY AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6218
Mailing Address - Country:US
Mailing Address - Phone:651-583-7899
Mailing Address - Fax:651-583-7907
Practice Address - Street 1:1599 SELBY AVE STE 208
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6218
Practice Address - Country:US
Practice Address - Phone:651-583-7899
Practice Address - Fax:651-583-7907
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical