Physician Compare National (NPI:1003192535)

HEALTHCARE PROVIDER: THETA P GRIBBINS PHD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1003192535
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204080393
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130124000358
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRIBBINS
	Individual professional last name
Provider First Name	THETA
	Individual professional first name
Provider Middle Name	PAULINE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	60 HILL POINTE CT
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 206
	Group Practice or individual's line 2 address
City	SAINT CHARLES
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	633034099
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6364939912
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y