DR. KELLY JOAN CARLSON GIBAS (NPI# 1588189955) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588189955 |
| Entity Type | Individual |
| Full Name | DR. KELLY JOAN CARLSON GIBAS |
| Credential | DBH |
| Practice Address |
13700 Reimer Dr N Ste 220 Maple Grove MN 55311-4548 |
| Mailing Address |
9060 203rd Ave Nw Elk River MN 55330-8052 |
| Practice Telephone | 7634242474 |
| Practice Fax Number | 7634242711 |
| Mailing Telephone | 7639134387 |
| Mailing Fax Number | 7634242711 |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2017-08-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
CC01539 | MN | Behavioral Health & Social Service Providers |
| N | 133NN1002X |
Nutritionist Specialization: Nutrition, Education |
MN | Dietary & Nutritional Service Providers | |
| N | 174H00000X | Health Educator | MN | Other Service Providers |
| Street Address |
13700 REIMER DR N STE 220 |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55311-4548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063781771 | Julie Ann Gomer | Psychologist | 13700 Reimer Dr N Ste 220, Maple Grove, MN 55311-4548 | 2011-12-26 |
| 1609429646 | Twin Towers, Inc. | Family Medicine | 13700 Reimer Dr N Ste 220, Maple Grove, MN 55311-4548 | 2019-07-18 |
| 1386109767 | Twin Towers, Inc. | Counselor | 13700 Reimer Dr N Ste 220, Maple Grove, MN 55311-4548 | 2019-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609391374 | Deborah Lynn Higgins | Foster Care Agency | 8288 Revelwood Place, Maple Grove, MN 55311 | 2017-08-03 |
| 1013457993 | Trillium Chiropractic & Wellness Pa | Chiropractor | 13700 Reimer Dr Suite 250, Maple Grove, MN 55311 | 2017-02-27 |
| 1720535263 | Fischer Vision PC | Optometrist | 13334 Bass Lake Road North, Maple Grove, MN 55311 | 2016-09-01 |
| 1033571062 | Iman Dadras Konestani | Marriage & Family Therapist | 9325 Garland Lane N Apt 108, Mapple Grove, MN 55311 | 2016-03-29 |
| 1902272685 | Todd Archbold | Social Worker | 18153 80th Pl N, Maple Grove, MN 55311 | 2015-08-17 |
| 1144634395 | Petersen Chiropractic Inc. | Chiropractor | 9505 Blackoaks Ln No., Maple Grove, MN 55311 | 2014-06-16 |
| 1972738276 | Sara Jean Bidler | Marriage & Family Therapist | 7026 E Fish Lake Rd, Maple Grove, MN 55311 | 2009-05-16 |
| 1962670026 | Helminger Chiropractic, P.a. | Chiropractor | 9479 Garland Lane North, Maple Grove, MN 55311 | 2008-02-12 |
| 1457579450 | Cynthia C Cassel | Physician Assistant | 6300 Wedgewood Way, Maple Grove, MN 55311 | 2007-04-23 |
| 1386860732 | Thomas Triden | Chiropractor | 7494 East Fish Lake Road, Maple Grove, MN 55311 | 2007-04-17 |
| Find all providers in zip 55311 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063781771 | Julie Ann Gomer | Psychologist | 13700 Reimer Dr N Ste 220, Maple Grove, MN 55311-4548 | 2011-12-26 |
| 1013116342 | Michelle K. Pemble | Psychologist | 9555 Upland Ln N, Maple Grove, MN 55369 | 2007-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347854 | Shining Light Skill Building LLC | Psychologist | 3055 Old Highway 8 Ste 106b, St. Anthony, MN 55418 | 2020-08-17 |
| 1245750652 | Sara Vaccarella | Psychologist | 331 W Superior St Ste 300, Duluth, MN 55802-4532 | 2017-06-27 |
| 1780124305 | Families First Counseling Services LLC | Psychologist | 103 S Kingston St, Caledonia, MN 55921-1315 | 2017-03-01 |
| 1598150930 | Nova Bhs | Psychologist | 521 Tanglewood Dr., Shoreview, MN 55126 | 2015-04-02 |
| 1801208566 | Rose Mary Boerboom | Psychologist | 415 N 1st St, #502, Minneapolis, MN 55401-4305 | 2014-05-28 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1992145288 | Rowan P Buckley | Psychologist | 6825 Owen St Ste 201, Loretto, MN 55357-9713 | 2013-07-01 |
| 1750697587 | Megan Horwitz Plumstead | Psychologist | 1619 Dayton Ave Ste 327, Saint Paul, MN 55104-6495 | 2010-08-31 |
| 1073826913 | Scott Michael Jacoby | Psychologist | 2110 Lyndale Ave S, Minneapolis, MN 55405-3196 | 2010-07-20 |
| 1316178296 | Elaine Marie Miller | Psychologist | 3604 S Oak Cir, Saint Cloud, MN 56301-4616 | 2009-07-27 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55311 |
Please comment or provide details below to improve the information on DR. KELLY JOAN CARLSON GIBAS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.