Healthcare Provider Details

I. General information

NPI: 1790305431
Provider Name (Legal Business Name): JAMES EDWARD GIBSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 QUARTZ CT
LONGMONT CO
80504-3933
US

IV. Provider business mailing address

928 QUARTZ CT
LONGMONT CO
80504-3933
US

V. Phone/Fax

Practice location:
  • Phone: 720-727-4012
  • Fax:
Mailing address:
  • Phone: 720-727-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023939
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACB.0008568
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACD.0002680
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: