MEDICARE: MRS. RUTH MURRAY GIBBS LPC

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
1	101YP2500X	Professional Counselor	0701004025	VA

General Provider Information

NPI Number	:	1659462935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH MURRAY GIBBS LPC

Provider Business Mailing Address
First Line	:	6121 HOMEWOOD CIR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-7612
Country	:	US
Telephone Number	:	540-776-9212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3451 BRANDON AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-1513
Country	:	US
Telephone Number	:	540-314-0443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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