Provider Demographics
NPI:1518657303
Name:GIBBS, KATY KEPNER
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:KEPNER
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 1:955 COUNTY ROAD 023
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-8388
Mailing Address - Country:US
Mailing Address - Phone:903-372-4295
Mailing Address - Fax:
Practice Address - Street 1:1329 N UNIVERSITY DR STE F5
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4225
Practice Address - Country:US
Practice Address - Phone:936-679-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional