Provider Demographics
NPI:1558952291
Name:GIBSON, TANNER (QMHS)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1612
Mailing Address - Country:US
Mailing Address - Phone:740-291-3737
Mailing Address - Fax:833-805-3653
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1612
Practice Address - Country:US
Practice Address - Phone:740-291-3737
Practice Address - Fax:833-805-3653
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator