Provider Demographics
NPI:1710520358
Name:GIBBS, CLEVELAND (BCBA)
Entity Type:Individual
Prefix:
First Name:CLEVELAND
Middle Name:
Last Name:GIBBS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W POINT CV
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3687
Mailing Address - Country:US
Mailing Address - Phone:615-506-9947
Mailing Address - Fax:
Practice Address - Street 1:700 CRAIGHEAD ST STE 105
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2254
Practice Address - Country:US
Practice Address - Phone:615-292-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst