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General NPI Number Information
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NPI Number | 1003192535
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Entity Type | Individual
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Provider Name | THETA P GRIBBINS PHD
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Gender | Female
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 60 HILL POINTE CT STE 206
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City | SAINT CHARLES
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State | MO
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Zip | 63303-4099
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Country | US
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Telephone | 636-493-9912
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Fax | 636-493-9913
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Provider Business Mailing Address
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Address Line | 60 HILL POINTE CT STE 206
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City | SAINT CHARLES
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State | MO
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Zip | 63303-4099
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Country | US
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Telephone | 636-493-9912
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Fax | 636-493-9913
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2011032755
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2011037832
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License Number State | MO
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