Provider Demographics
NPI:1508000886
Name:GIBBS, KIMBERLY MICHELLE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4200
Mailing Address - Country:US
Mailing Address - Phone:562-896-4694
Mailing Address - Fax:
Practice Address - Street 1:6621 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4200
Practice Address - Country:US
Practice Address - Phone:562-896-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist