Patty Gibbs
Individual provider Active NPI Professional Counselor · Davenport, IA
NPI 1750782850 · NPPES record last updated Sep 8, 2014
Key facts
- NPI
- 1750782850
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 072526 (IA)
- Practice address
- 4117 N Linwood Ave
Davenport, IA 52806-4935 - Phone
- (563) 949-0780
- NPI assigned
- Sep 8, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2005
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4117 N Linwood Ave
Davenport, IA 52806-4935
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240406000318 | IA | Practitioner - Mental Health Counselor | 2062850233 | Reassigns benefits to 2 organizations |
| I20260528000100 | IL | Practitioner - Mental Health Counselor | 2062850233 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 072526 | IA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PJG and Associates | Professional | Current |
Accepting new patients |
| PJG and Associates | Professional | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 072526 | IA | Yes |
Addresses
Primary practice location
4117 N Linwood Ave
Davenport, IA 52806-4935
Mailing address
4117 N Linwood Ave
Davenport, IA 52806-4935
Other providers in Davenport, IA
- Genventures, Inc.
- Dietrich A Gerhardt
- Allison Maher Germundson
- Getnresults, L.L.C.
- Husam Saba Elias Ghawi
- Lauren Elizabeth Gil Hayes
- Robert J. Gilbert
- Emily Lynn Gillen
- Jordan Gillund
- Lloyd D Gillund
All providers in Davenport, IA · Professional Counselor in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.