MEDICARE: HAROLD M & HAROLD GIBSON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	88553	TX

General Provider Information

NPI Number	:	1194576066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD M & HAROLD GIBSON LPC

Provider Business Mailing Address
First Line	:	1509 VILLAGE COURT CIR
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-6162
Country	:	US
Telephone Number	:	195-675-5961
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 VILLAGE COURT CIR
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77471-6162
Country	:	US
Telephone Number	:	956-755-9619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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