Healthcare Provider Details

I. General information

NPI: 1164353439
Provider Name (Legal Business Name): GIBBONS AKENJI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 BROOKVIEW DR
TOLEDO OH
43615-7503
US

IV. Provider business mailing address

1114 BROOKVIEW DR
TOLEDO OH
43615-7503
US

V. Phone/Fax

Practice location:
  • Phone: 945-267-0835
  • Fax: 945-267-0835
Mailing address:
  • Phone: 945-267-0835
  • Fax: 945-267-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: