Healthcare Provider Details

I. General information

NPI: 1932362001
Provider Name (Legal Business Name): SHANTRICE LASHAUN GIBSON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47185 COOPER FOSTER PARK RD
AMHERST OH
44001-3307
US

IV. Provider business mailing address

47185 COOPER FOSTER PARK RD
AMHERST OH
44001-3307
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-3954
  • Fax: 440-960-3956
Mailing address:
  • Phone: 440-960-3954
  • Fax: 440-960-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number795
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08675
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: