Provider Demographics
NPI:1316792278
Name:GIBBONS, TRISTA J (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:J
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 TERRE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2445
Mailing Address - Country:US
Mailing Address - Phone:812-229-3729
Mailing Address - Fax:
Practice Address - Street 1:243 TERRE VISTA DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2445
Practice Address - Country:US
Practice Address - Phone:812-229-3729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001644A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist