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NPI Code Detail

MEDICARE: GWENDOLYN A. GIBBS

MEDICARE: GWENDOLYN A. GIBBS
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1639202906
Entity Type Code : Organization
Provider Name (Legal Business Name) : GWENDOLYN A. GIBBS
Provider Business Mailing Address
First Line : PO BOX 451485
Second Line :
City : HOUSTON
State : TX
Zip : 77245-1485
Country : US
Telephone Number : 713-433-0528
Fax Number : 713-433-1462
Provider Business Practice Location Address
First Line : 5331 W OREM DR
Second Line :
City : HOUSTON
State : TX
Zip : 77045-5036
Country : US
Telephone Number : 713-433-0528
Fax Number : 713-433-1462
Authorized Official
Title or Position : CEO
Name : GWENDOLYN ARNETTA GIBBS
Credential :
Telephone Number : 832-818-4443
Provider Enumeration Date : 03/14/2007
Last Update Date : 04/09/2008

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