Provider Demographics
NPI:1083875777
Name:SHIBL, GRETCHEN (PSYD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:SHIBL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23461 S POINTE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1547
Mailing Address - Country:US
Mailing Address - Phone:949-855-1556
Mailing Address - Fax:949-951-2871
Practice Address - Street 1:23461 S POINTE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1547
Practice Address - Country:US
Practice Address - Phone:949-855-1556
Practice Address - Fax:949-951-2871
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical