MEDICARE: REANAH GIBSON BCBA

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	103K00000X	Behavior Analyst	1-24-74091	FL
2	106S00000X	Behavior Technician	RBT-20-115644	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982224572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REANAH GIBSON BCBA

Provider Business Mailing Address
First Line	:	7392 MEAD DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4319
Country	:	US
Telephone Number	:	678-646-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	8348 LITTLE RD STE 201
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-4919
Country	:	US
Telephone Number	:	352-540-5711
Fax Number	:

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

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	12/29/2025

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