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General NPI Number Information
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NPI Number | 1730487901
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Entity Type | Organization
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Legal Business Name | GIBAULT, INC.
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 6401 S US HIGHWAY 41
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4749
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Country | US
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Telephone | 812-298-3002
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Fax | 812-298-3044
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Provider Business Mailing Address
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Address Line | 6401 S US HIGHWAY 41
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4749
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Country | US
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Telephone | 812-298-3002
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Fax | 812-298-3044
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Authorized Official
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Title or Position | PREIDENT/CEO
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Name | MRS. MICHELE MADLEY
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Credential | MS LMHC
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Telephone | 812-298-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 73856
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License Number State | IN
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