Provider Demographics
NPI:1154538171
Name:GIBB, RICHARD PRICE (DMH)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PRICE
Last Name:GIBB
Suffix:
Gender:M
Credentials:DMH
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 1208
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-1208
Mailing Address - Country:US
Mailing Address - Phone:707-964-6191
Mailing Address - Fax:707-964-6191
Practice Address - Street 1:1102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-964-6191
Practice Address - Fax:707-964-6191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6138313OtherUSBH
CA6138313OtherUSBH