| Doctor Name: | MS. TINA WIBSTAD |
| NPI Number: | 1518275130 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW, CADC I |
| License Number: | 12-06-70 |
| Business Practice Address: | 906 Main Ave Tillamook, OR - 971413816 |
| Business Phone Number: | 5038428201 |
| Business Fax Number: | 5038151870 |
| Mailing Address: | 906 Main Ave, TILLAMOOK |
| State: | OR |
| Postal Code: | 971413816 |
| Phone Number: | 5038428201 |
| Fax Number: | 5038151870 |
| NPI Enumeration Date: | 09/16/2010 |
| NPI Last Update Date: | 02/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 12-06-70 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |