Provider Demographics
NPI:1891193215
Name:GIBBS, CHRISTEN LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:LYNN
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-1927
Mailing Address - Country:US
Mailing Address - Phone:502-637-4361
Mailing Address - Fax:502-637-4490
Practice Address - Street 1:225 W BRECKINRIDGE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2219
Practice Address - Country:US
Practice Address - Phone:502-637-4361
Practice Address - Fax:502-637-4490
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100327170Medicaid
KY7100327170Medicaid