Gary Liebert Jr., CIT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

4247 Issued in LA

Practice address

401 W Vermilion St
Lafayette, LA 70501-6729

Phone

(337) 354-9736

NPI assigned

Apr 27, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1033730494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 W VERMILION ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705016729",
            "telephone_number": "337-354-9736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W VERMILION ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705016729",
            "telephone_number": "337-354-9736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERT",
        "first_name": "GARY",
        "name_suffix": "Jr.",
        "credential": "CIT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-27",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "4247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gliebert@woodlakecenter.com",
            "affiliation": "N",
            "endpointDescription": "gliebert@woodlakecenter.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "401 W Vermilion St",
            "city": "Lafayette",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705016729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.