Provider Demographics
NPI:1689965915
Name:GIBLER, ROBIN C (MA LPC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:C
Last Name:GIBLER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19303
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0303
Mailing Address - Country:US
Mailing Address - Phone:503-422-7987
Mailing Address - Fax:503-914-1561
Practice Address - Street 1:7822 SW CAPITOL HWY STE 5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2495
Practice Address - Country:US
Practice Address - Phone:503-422-7987
Practice Address - Fax:503-914-1561
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3378101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164936Medicaid
OR0000WDBCHMedicare PIN