Provider Demographics
NPI:1710665872
Name:GIBBS, MARSHALL SCOTT (LMFT)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:SCOTT
Last Name:GIBBS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DENTON RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6404
Mailing Address - Country:US
Mailing Address - Phone:415-652-6008
Mailing Address - Fax:
Practice Address - Street 1:11 DENTON RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6404
Practice Address - Country:US
Practice Address - Phone:415-652-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98571106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist