Doctor Name: | JASON SIBSON |
NPI Number: | 1003237090 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., PLPC |
License Number: | 2013043796 |
Business Practice Address: | 909 E State Blvd Fort Wayne, IN - 468053404 |
Business Phone Number: | 2604812700 |
Business Fax Number: | 2604812709 |
Mailing Address: | 909 E State Blvd, FORT WAYNE |
State: | IN |
Postal Code: | 468053404 |
Phone Number: | 2604812700 |
Fax Number: | 2604812709 |
NPI Enumeration Date: | 12/18/2013 |
NPI Last Update Date: | 08/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2013043796 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |