Provider Demographics
NPI:1295867901
Name:GIBBS, WYLMA JOYCE (MFT)
Entity type:Individual
Prefix:
First Name:WYLMA
Middle Name:JOYCE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 EFFIE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1711
Mailing Address - Country:US
Mailing Address - Phone:323-644-2000
Mailing Address - Fax:323-644-2793
Practice Address - Street 1:1789 WALWORTH AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1238
Practice Address - Country:US
Practice Address - Phone:626-827-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist