Provider Demographics
NPI:1598346876
Name:GIBBS COMPREHENSIVE CARE, LLC
Entity Type:Organization
Organization Name:GIBBS COMPREHENSIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PMHNP-BC
Authorized Official - Phone:601-692-8997
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:TOOMSUBA
Mailing Address - State:MS
Mailing Address - Zip Code:39364-0188
Mailing Address - Country:US
Mailing Address - Phone:601-692-8997
Mailing Address - Fax:601-531-3107
Practice Address - Street 1:7106 SUMTER 27
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:AL
Practice Address - Zip Code:36907-9681
Practice Address - Country:US
Practice Address - Phone:601-692-8997
Practice Address - Fax:601-531-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-18
Last Update Date:2021-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty