Healthcare Provider Details

I. General information

NPI: 1588386585
Provider Name (Legal Business Name): ANDREW CARL ARLAND GIBBONS III M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 S HIGLEY RD STE 126
MESA AZ
85206-3450
US

IV. Provider business mailing address

1423 S HIGLEY RD STE 126
MESA AZ
85206-3450
US

V. Phone/Fax

Practice location:
  • Phone: 480-995-6645
  • Fax:
Mailing address:
  • Phone: 480-995-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-GA-1972
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-23648
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23648
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-MN-429
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-OH-430
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-IN-1973
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: