Provider Demographics
NPI:1366231474
Name:TIBBETS, LISA (LPC ASSOCIATE)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TIBBETS
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S STONEBRIDGE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8023
Mailing Address - Country:US
Mailing Address - Phone:469-209-6900
Mailing Address - Fax:
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 203
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8023
Practice Address - Country:US
Practice Address - Phone:469-209-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98077101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty