Provider Demographics
NPI:1891577276
Name:GIBBS, PEYTON DIXIE (TLPC/MHSP)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:DIXIE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:TLPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 INDIAN LAKE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3884
Mailing Address - Country:US
Mailing Address - Phone:615-461-0093
Mailing Address - Fax:
Practice Address - Street 1:131 INDIAN LAKE RD STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3884
Practice Address - Country:US
Practice Address - Phone:615-461-0093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional