Provider Demographics
NPI:1053345611
Name:GIBBS, KATHERINE NMI
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:NMI
Last Name:GIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 880066
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-0066
Mailing Address - Country:US
Mailing Address - Phone:970-879-7540
Mailing Address - Fax:970-870-6682
Practice Address - Street 1:1125 LINCOLN AVE.
Practice Address - Street 2:WEST PARK PLACE BLDG
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-7540
Practice Address - Fax:970-870-6682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO072278Medicaid
CO73585254Medicaid
CO802901Medicare ID - Type UnspecifiedNORIDIAN