Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY254 | NV |
Y | 103TC0700X | Clinical Psychologist | PY254 | NV |
NPI | 1013150135 |
---|---|
Provider Name | Dr. Carol Tibbals |
First Address | Schurz, NV 89427 |
Second Address | Schurz, NV 89427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2009 |
Last Update Date | 20/04/2009 |