Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1437538634 |
---|---|
Provider Name | Robert Thomas Libey |
First Address | Tulsa, OK 74135-6106 |
Second Address | Tulsa, OK 74135-6106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 21/05/2015 |