Provider Demographics
NPI:1083761621
Name:GIBSON, SHERRI (PHD)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 N PALM AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1800
Mailing Address - Country:US
Mailing Address - Phone:559-431-1900
Mailing Address - Fax:559-431-1951
Practice Address - Street 1:5740 N PALM AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1800
Practice Address - Country:US
Practice Address - Phone:559-431-1900
Practice Address - Fax:559-431-1951
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL126250Medicare ID - Type Unspecified