Provider Demographics
NPI:1235363482
Name:GIBBS, PATRICIA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:GIBBS
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 1:22731 NEWMAN ST
Mailing Address - Street 2:SUITE #235
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2034
Mailing Address - Country:US
Mailing Address - Phone:313-274-5490
Mailing Address - Fax:
Practice Address - Street 1:22731 NEWMAN ST
Practice Address - Street 2:SUITE #235
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2034
Practice Address - Country:US
Practice Address - Phone:313-274-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-03
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003319103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist