Provider Demographics
NPI:1356489009
Name:BIBERSTEIN, BILLY JOE JR (PHD)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:JOE
Last Name:BIBERSTEIN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:B.
Other - Middle Name:JOSEPH
Other - Last Name:BIBERSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:700 W AVENUE D
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-2813
Mailing Address - Country:US
Mailing Address - Phone:361-994-0387
Mailing Address - Fax:
Practice Address - Street 1:5934 S STAPLES ST STE 206
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3842
Practice Address - Country:US
Practice Address - Phone:361-994-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60216101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor