Provider Demographics
NPI:1730487901
Name:GIBAULT, INC.
Entity Type:Organization
Organization Name:GIBAULT, INC.
Other - Org Name:GIBAULT CHILDREN'S SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PREIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC
Authorized Official - Phone:812-298-3002
Mailing Address - Street 1:6401 S US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4749
Mailing Address - Country:US
Mailing Address - Phone:812-298-3002
Mailing Address - Fax:812-298-3044
Practice Address - Street 1:6401 S US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4749
Practice Address - Country:US
Practice Address - Phone:812-298-3002
Practice Address - Fax:812-298-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73856323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201006620Medicaid