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NPI Code Detail

MEDICARE: MR. SIDNEY LANIER GIBSON JR. LMHC

MEDICARE: MR. SIDNEY LANIER GIBSON JR. LMHC
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
1101YM0800XMental Health CounselorMH0000122FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619929536
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SIDNEY LANIER GIBSON JR. LMHC
Provider Business Mailing Address
First Line : 4107 W SPRUCE ST STE 100
Second Line :
City : TAMPA
State : FL
Zip : 33607-2346
Country : US
Telephone Number : 813-636-8811
Fax Number :
Provider Business Practice Location Address
First Line : 4107 W SPRUCE ST STE 100
Second Line :
City : TAMPA
State : FL
Zip : 33607-2346
Country : US
Telephone Number : 813-636-8811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 11/23/2025

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