Healthcare Provider Details

I. General information

NPI: 1770617490
Provider Name (Legal Business Name): SEAN GIBBS PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 S I 10 SERVICE RD W STE 200
METAIRIE LA
70001-1874
US

IV. Provider business mailing address

1202 MONROE ST
GRETNA LA
70053-2307
US

V. Phone/Fax

Practice location:
  • Phone: 504-838-5424
  • Fax: 504-838-5714
Mailing address:
  • Phone: 504-309-6798
  • Fax: 504-407-2115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1492
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberIMF49880
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: