Provider Demographics
NPI:1447685839
Name:BRAD SIBILLE LLC
Entity type:Organization
Organization Name:BRAD SIBILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SIBILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:337-945-1032
Mailing Address - Street 1:333 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6137
Mailing Address - Country:US
Mailing Address - Phone:337-945-1032
Mailing Address - Fax:337-678-1893
Practice Address - Street 1:333 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6137
Practice Address - Country:US
Practice Address - Phone:337-945-1032
Practice Address - Fax:337-678-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3363691Medicaid