Provider Demographics
NPI:1306631619
Name:GIBBS, MIRANDA TAYLOR (BCBA)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:TAYLOR
Last Name:GIBBS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:KY
Mailing Address - Zip Code:40026-8746
Mailing Address - Country:US
Mailing Address - Phone:636-675-5348
Mailing Address - Fax:
Practice Address - Street 1:8735 OLD BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4490
Practice Address - Country:US
Practice Address - Phone:502-208-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst