Provider Demographics
NPI:1538205786
Name:LIBEL, PEGGY L (LMLP)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:L
Last Name:LIBEL
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:WATHENA
Mailing Address - State:KS
Mailing Address - Zip Code:66090-0324
Mailing Address - Country:US
Mailing Address - Phone:785-989-7979
Mailing Address - Fax:
Practice Address - Street 1:1301 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1202
Practice Address - Country:US
Practice Address - Phone:913-367-1593
Practice Address - Fax:913-367-1627
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS920103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10117700AMedicaid