MEDICARE: LUCY THERESA GIBBS

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	:	1588581862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY THERESA GIBBS

Provider Business Mailing Address
First Line	:	4620 S SLAUSON AVE APT 202
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-5181
Country	:	US
Telephone Number	:	805-550-6929
Fax Number	:

Provider Business Practice Location Address
First Line	:	8616 LA TIJERA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3944
Country	:	US
Telephone Number	:	310-337-7827
Fax Number	:

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

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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