Provider Demographics
NPI:1144342049
Name:SIBLEY, ANDY (LMFT, LPC)
Entity type:Individual
Prefix:MR
First Name:ANDY
Middle Name:
Last Name:SIBLEY
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3022
Mailing Address - Country:US
Mailing Address - Phone:318-221-8581
Mailing Address - Fax:318-221-8581
Practice Address - Street 1:2520 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3022
Practice Address - Country:US
Practice Address - Phone:318-221-8581
Practice Address - Fax:318-221-8581
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2841101YP2500X
LA830106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional