Provider Demographics
NPI:1881999183
Name:GIBBS, ETIENNE ANTHONY (LMSW)
Entity type:Individual
Prefix:MR
First Name:ETIENNE
Middle Name:ANTHONY
Last Name:GIBBS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 CEDAR ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2383
Mailing Address - Country:US
Mailing Address - Phone:563-263-7410
Mailing Address - Fax:563-263-7506
Practice Address - Street 1:2925 CEDAR ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2383
Practice Address - Country:US
Practice Address - Phone:563-263-7410
Practice Address - Fax:563-263-7506
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID007358104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker