Provider Demographics
NPI:1023159571
Name:GIBBENS, KATIE PITRE (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:PITRE
Last Name:GIBBENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:E
Other - Last Name:PITRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:521 LEGION AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3339
Mailing Address - Country:US
Mailing Address - Phone:985-447-0884
Mailing Address - Fax:
Practice Address - Street 1:521 LEGION AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3339
Practice Address - Country:US
Practice Address - Phone:985-447-0884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
LA84931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker