Healthcare Provider Details

I. General information

NPI: 1013965839
Provider Name (Legal Business Name): MELANIE GIBBS MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 E US HIGHWAY 36 STE 500
AVON IN
46123-9781
US

IV. Provider business mailing address

308 MEDIC WAY
GREENCASTLE IN
46135-2296
US

V. Phone/Fax

Practice location:
  • Phone: 216-468-5000
  • Fax:
Mailing address:
  • Phone: 765-653-2669
  • Fax: 765-653-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004759
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: