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General NPI Number Information
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NPI Number | 1144387820
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Entity Type | Individual
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Provider Name | PHILIP JOSEPH GIBEAU PHD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20 SOUTH LIMESTONE ST STE 340
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City | SPRINGFIELD
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State | OH
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Zip | 45502
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Country | US
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Telephone | 937-325-3370
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Fax | 937-325-3432
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Provider Business Mailing Address
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Address Line | 30 KENSINGTON PLACE SOUTH 20 SOUTH LIMESTONE ST STE 340
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City | SPRINGFIELD
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State | OH
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Zip | 45504
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Country | US
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Telephone | 937-399-1026
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Fax | 937-325-3432
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2851
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License Number State | OH
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