Provider Demographics
NPI:1982224572
Name:GIBSON, REANAH (BCBA)
Entity type:Individual
Prefix:
First Name:REANAH
Middle Name:
Last Name:GIBSON
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 1:7392 MEAD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4319
Mailing Address - Country:US
Mailing Address - Phone:678-646-9999
Mailing Address - Fax:
Practice Address - Street 1:9405 BARNSTEAD LN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4302
Practice Address - Country:US
Practice Address - Phone:727-967-2809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-20-115644106S00000X
FL1-24-74091103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician