Provider Demographics
NPI:1386760700
Name:GIBBS, CASEY L (QMHA)
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:L
Last Name:GIBBS
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SE 50TH AVE
Mailing Address - Street 2:APT.18
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2200
Mailing Address - Country:US
Mailing Address - Phone:503-753-6868
Mailing Address - Fax:
Practice Address - Street 1:2270 SE 39TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5916
Practice Address - Country:US
Practice Address - Phone:503-963-8337
Practice Address - Fax:503-963-8365
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171M00000XOtherQMHA