Provider Demographics
NPI:1205236841
Name:TIBBLES, AMY SUZANNE (LMHC, LCPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUZANNE
Last Name:TIBBLES
Suffix:
Gender:F
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13760 TIBBLES LN
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8236
Mailing Address - Country:US
Mailing Address - Phone:360-770-7634
Mailing Address - Fax:
Practice Address - Street 1:1019 10TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4139
Practice Address - Country:US
Practice Address - Phone:360-770-7634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC50714101YM0800X
WALH60851405101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LCPC-LIC-50714OtherMONTANA STATE LICENSE