Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 2013043796 | MO |
Y | 103G00000X | Clinical Psychologist | 911 | NE |
Y | 103TC0700X | Clinical Psychologist | 911 | NE |
NPI | 1003237090 |
---|---|
Provider Name | Dr. Jason Sibson |
First Address | Lincoln, NE 68508-1334 |
Second Address | Lincoln, NE 68516-6652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2013 |
Last Update Date | 29/11/2016 |