Provider Demographics
NPI:1457947806
Name:GIBSON, TIFFANY LOUISE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LOUISE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40680 HIGHWAY 41 STE D
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9657
Mailing Address - Country:US
Mailing Address - Phone:559-267-3552
Mailing Address - Fax:209-317-4020
Practice Address - Street 1:5320 HIGHWAY 49 N STE A
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9588
Practice Address - Country:US
Practice Address - Phone:559-267-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor