Organization
GIBBS COMPREHENSIVE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACI LYNN GIBBS NP (OWNER)
(601) 692-8997
Entity
Organization
Contact information
Practice address
101 REEVES STREET, BERNICE, LA 71222
(601) 531-3200
(601) 531-3107
Mailing address
PO BOX 188, TOOMSUBA, MS 39364-0188
(601) 531-3200
(601) 531-3107
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03673567
—
MS
05
—
2487949
—
LA
Enumeration date
10/17/2018
Last updated
10/23/2019
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