MEDICARE: BRIANA LIN GIBSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1245719467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA LIN GIBSON

Provider Business Mailing Address
First Line	:	21600 OXNARD ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-4976
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 GROVEDALE DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-2504
Country	:	US
Telephone Number	:	571-290-0143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	07/20/2023

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Directions to “ BRIANA LIN GIBSON ” Practice Location

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