Healthcare Provider Details

I. General information

NPI: 1669526232
Provider Name (Legal Business Name): ROBERT GENE GIBBS JR. CDP, RC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 AUBURN WAY N
AUBURN WA
98002-4117
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 253-352-3900
  • Fax:
Mailing address:
  • Phone: 425-277-1311
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCP00004227
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00037756
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: