Provider Demographics
NPI:1548717655
Name:LYBBERT, TANEISHA CORTNEY
Entity type:Individual
Prefix:MRS
First Name:TANEISHA
Middle Name:CORTNEY
Last Name:LYBBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANEISHA
Other - Middle Name:CORTNEY
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:323 E 2ND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1455
Mailing Address - Country:US
Mailing Address - Phone:509-418-4484
Mailing Address - Fax:509-381-3470
Practice Address - Street 1:323 E 2ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1455
Practice Address - Country:US
Practice Address - Phone:509-418-4484
Practice Address - Fax:509-381-3470
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61502070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health