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NPI Code Detail

MEDICARE: MS. CASEY L GIBBS QMHA

MEDICARE: MS. CASEY L GIBBS QMHA
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1171M00000XOTHERORQMHA

General Provider Information

NPI Number : 1386760700
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CASEY L GIBBS QMHA
Provider Business Mailing Address
First Line : 2925 SE 50TH AVE
Second Line : APT.18
City : PORTLAND
State : OR
Zip : 97206-2200
Country : US
Telephone Number : 503-753-6868
Fax Number :
Provider Business Practice Location Address
First Line : 2270 SE 39TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-5916
Country : US
Telephone Number : 503-963-8337
Fax Number : 503-963-8365
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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