Healthcare Provider Details

I. General information

NPI: 1598346876
Provider Name (Legal Business Name): GIBBS COMPREHENSIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 4TH AVE
YORK AL
36925-2104
US

IV. Provider business mailing address

PO BOX 188
TOOMSUBA MS
39364-0188
US

V. Phone/Fax

Practice location:
  • Phone: 601-531-3200
  • Fax: 601-531-3107
Mailing address:
  • Phone: 601-531-3200
  • Fax: 601-531-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACI LYNN GIBBS
Title or Position: OWNER
Credential: PHD, PMHNP-BC
Phone: 601-531-3200