Provider Demographics
NPI:1003192535
Name:GRIBBINS, THETA P (PHD)
Entity Type:Individual
Prefix:
First Name:THETA
Middle Name:P
Last Name:GRIBBINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:60 HILL POINTE CT STE 206
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4099
Mailing Address - Country:US
Mailing Address - Phone:636-493-9912
Mailing Address - Fax:636-493-9913
Practice Address - Street 1:60 HILL POINTE CT STE 206
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-4099
Practice Address - Country:US
Practice Address - Phone:636-493-9912
Practice Address - Fax:636-493-9913
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2012-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2011032755101YP2500X
MO2011037832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO232812942OtherSAINT LOUIS BEHAVIORAL MEDICINE INSTITUTE
MO46-0760135OtherST CHARLES PSYCH TESTING & THERAPY