Provider Demographics
NPI:1982045118
Name:GIBBS, JORDAN PHIFER (BA)
Entity Type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:PHIFER
Last Name:GIBBS
Suffix:
Gender:F
Credentials:BA
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 839
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0839
Mailing Address - Country:US
Mailing Address - Phone:662-286-9883
Mailing Address - Fax:662-284-9836
Practice Address - Street 1:401 NEW HOPE DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7458
Practice Address - Country:US
Practice Address - Phone:662-287-7199
Practice Address - Fax:662-286-8908
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)