Provider Demographics
NPI:1285180349
Name:GIBBS, MONA
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 N 31ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3900
Mailing Address - Country:US
Mailing Address - Phone:318-855-3868
Mailing Address - Fax:318-537-9688
Practice Address - Street 1:806 N 31ST ST STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-855-3868
Practice Address - Fax:318-537-9688
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA000Medicaid