Provider Demographics
NPI:1942349089
Name:PANTHER-GIBBY, BARBARA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:M
Last Name:PANTHER-GIBBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 MOUNTAIN VIEW LANE
Mailing Address - Street 2:STE. 500
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2248
Mailing Address - Country:US
Mailing Address - Phone:503-357-0206
Mailing Address - Fax:503-357-9003
Practice Address - Street 1:1911 MOUNTAIN VIEW LANE
Practice Address - Street 2:STE. 500
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2248
Practice Address - Country:US
Practice Address - Phone:503-357-0206
Practice Address - Fax:503-357-9003
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1178103TC0700X
WA1973103TC0700X
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228839Medicaid
OR0000TCPFTMedicare UPIN