Provider Demographics
NPI:1134335631
Name:GIBBONS, BEVERLY COYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:COYNE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9322 MILLSTONE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-4223
Mailing Address - Country:US
Mailing Address - Phone:865-694-7859
Mailing Address - Fax:865-690-2934
Practice Address - Street 1:9322 MILLSTONE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-4223
Practice Address - Country:US
Practice Address - Phone:865-694-7859
Practice Address - Fax:865-690-2934
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical