Provider Demographics
NPI:1346928264
Name:GIBBS, TICHANA (LPC)
Entity Type:Individual
Prefix:
First Name:TICHANA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N CENTRAL EXPY UNIT 2282
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-0122
Mailing Address - Country:US
Mailing Address - Phone:281-810-8483
Mailing Address - Fax:
Practice Address - Street 1:5301 ALPHA RD STE 80
Practice Address - Street 2:#6012
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4393
Practice Address - Country:US
Practice Address - Phone:210-744-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health