Individual
RUSSELL C. GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2053 GAUSE BLVD E STE 150, SLIDELL, LA 70461-5451
(985) 649-1001
Mailing address
2053 GAUSE BLVD E STE 150, SLIDELL, LA 70461-5451
(985) 649-1001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
012158399
LA
Other
Enumeration date
08/03/2018
Last updated
08/03/2018
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