Active NPI
Keith Gordon Tibbetts, LCPC
- Professional Counselor
- Hampden, ME
National Provider Identifier
1285983262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- XL3783
- Practice address
- 50 Emerald Drive
Hampden, ME 04444 - Phone
- (207) 307-4505
- Fax
- (207) 941-2955
- NPI assigned
- Sep 5, 2012
- Last updated
- Jun 27, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | XL3783 | ME | Primary |
Addresses
Primary practice location
50 Emerald Drive
Hampden, ME 04444
Mailing address
50 Emerald Drive
Hampden, ME 04444
Phone (207) 307-4505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| XL3783 | ME | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719446400000",
"number": "1285983262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 EMERALD DRIVE",
"city": "HAMPDEN",
"state": "ME",
"postal_code": "04444",
"telephone_number": "207-307-4505",
"fax_number": "207-941-2955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 EMERALD DRIVE",
"city": "HAMPDEN",
"state": "ME",
"postal_code": "04444",
"telephone_number": "207-307-4505",
"fax_number": "207-941-2955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIBBETTS",
"first_name": "KEITH",
"middle_name": "GORDON",
"name_prefix": "Mr.",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-05",
"last_updated": "2024-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ME",
"license": "XL3783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hampden, ME
- Sunbury Primary Care, P.a. (Hampden Family Medicine)
- Tardif Community Therapy & Wellness PA
- Dana Paul Tardif, P.T. ; LMT
- Michael P Tardif, PT
- The Corson's Home
- Town of Hampden (Hampden Fire Department)
- True North Chiropractic PC
- Gail Marie Tudor, M.A., CCC-SLP
- Alissa A Wade, RDH
- Walgreen Eastern Co Inc (Walgreens #18112)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.