Provider Demographics
NPI:1447990817
Name:JAMES L BIBB, PHD LLC
Entity type:Organization
Organization Name:JAMES L BIBB, PHD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-375-1850
Mailing Address - Street 1:45-020A MALULANI STREET
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:808-375-1850
Mailing Address - Fax:808-235-6622
Practice Address - Street 1:45-020A MALULANI STREET
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-375-1850
Practice Address - Fax:808-235-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service