Healthcare Provider Details

I. General information

NPI: 1942236864
Provider Name (Legal Business Name): GEORGE F GIBBS M DIV LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 UPHAM DRIVE
COLUMBUS OH
43210
US

IV. Provider business mailing address

1670 UPHAM DR.
COLUMBUS OH
43210-1250
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9600
  • Fax: 614-293-9467
Mailing address:
  • Phone: 614-293-9600
  • Fax: 614-293-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberE0001606
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: