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Individual

THADDEUS GIBSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
15638 WESTERN SKIES DR, HOUSTON, TX 77086-1169
(832) 756-3681
Mailing address
15638 WESTERN SKIES DR, HOUSTON, TX 77086-1169
(832) 756-3681

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
323P00000X
Psychiatric Residential Treatment Facility
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care

Other

Enumeration date
04/13/2020
Last updated
04/13/2020
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