Provider Demographics
NPI:1679610836
Name:TIBBS, GLENNA M (LMHC)
Entity type:Individual
Prefix:MS
First Name:GLENNA
Middle Name:M
Last Name:TIBBS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 SW 43RD LN
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7520
Mailing Address - Country:US
Mailing Address - Phone:239-549-4346
Mailing Address - Fax:239-242-6389
Practice Address - Street 1:923 DEL PRADO BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3652
Practice Address - Country:US
Practice Address - Phone:239-464-0570
Practice Address - Fax:239-242-6389
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health