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NPI Code Detail

MEDICARE: TERRI K GIBSON CDCA

MEDICARE: TERRI K GIBSON CDCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician164675OH
2171M00000XCase Manager/Care Coordinator164675OH
3101YA0400XAddiction (Substance Use Disorder) Counselor164675OH

General Provider Information

NPI Number : 1316463649
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRI K GIBSON CDCA
Provider Business Mailing Address
First Line : 100 CROWNE POINT PL
Second Line :
City : CINCINNATI
State : OH
Zip : 45241-5427
Country : US
Telephone Number : 513-743-7628
Fax Number :
Provider Business Practice Location Address
First Line : 1620 HARRISON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45214-1410
Country : US
Telephone Number : 513-914-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2017
Last Update Date : 04/09/2024

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