Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 63010M370 | MI |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 63010M370 | MI |
N | 103G00000X | Clinical Psychologist | 63010M370 | MI |
N | 103TC0700X | Clinical Psychologist | 63010M370 | MI |
NPI | 1114967361 |
---|---|
Provider Name | Dr. Stephen Hibbard |
First Address | Plymouth, MI 48170-6262 |
Second Address | Plymouth, MI 48170-6262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |