Provider Demographics
NPI:1497513162
Name:BIBB, GAIL (LMFT, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:BIBB
Suffix:
Gender:F
Credentials:LMFT, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 EVERGREEN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1076
Mailing Address - Country:US
Mailing Address - Phone:502-632-3282
Mailing Address - Fax:
Practice Address - Street 1:308 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1076
Practice Address - Country:US
Practice Address - Phone:502-632-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2572021041C0700X
KY278391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical