| Doctor Name: | THETA P GRIBBINS |
| NPI Number: | 1003192535 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 2011032755 |
| Business Practice Address: | 60 Hill Pointe Ct Ste 206 Saint Charles, MO - 633034099 |
| Business Phone Number: | 6364939912 |
| Business Fax Number: | 6364939913 |
| Mailing Address: | 60 Hill Pointe Ct Ste 206, SAINT CHARLES |
| State: | MO |
| Postal Code: | 633034099 |
| Phone Number: | 6364939912 |
| Fax Number: | 6364939913 |
| NPI Enumeration Date: | 10/28/2011 |
| NPI Last Update Date: | 10/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2011032755 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |