| Doctor Name: | MR. GERALD W. THIBAULT |
| NPI Number: | 1083697270 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCPC |
| License Number: | CC1829 |
| Business Practice Address: | 157 Waterville Road Suite 2 Skowhegan, ME - 04976 |
| Business Phone Number: | 2074743477 |
| Business Fax Number: | |
| Mailing Address: | 27 Beech Street, SKOWHEGAN |
| State: | ME |
| Postal Code: | 04976 |
| Phone Number: | 2074743477 |
| Fax Number: | |
| NPI Enumeration Date: | 11/22/2005 |
| NPI Last Update Date: | 06/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | CC1829 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |