Basic Information
| Provider Information | |||||||||
| NPI: | 1356512420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CIBART | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5934 WAGON WHEEL WAY | ||||||||
| Address2: | |||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959693035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308777480 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 592 RIO LINDO AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959261817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.