Provider Demographics
NPI:1780042770
Name:GIBB, KRISTIN JOY
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:JOY
Last Name:GIBB
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:JOY
Other - Last Name:GORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMHCA
Mailing Address - Street 1:7618 SE RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4332
Mailing Address - Country:US
Mailing Address - Phone:503-544-4340
Mailing Address - Fax:
Practice Address - Street 1:945 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2555
Practice Address - Country:US
Practice Address - Phone:360-414-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60630862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health