Healthcare Provider Details

I. General information

NPI: 1346098209
Provider Name (Legal Business Name): GIBSON INTERVENTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 LINDA LN
BOWLING GREEN KY
42101-8035
US

IV. Provider business mailing address

529 COUNTRYWOOD PL
BOWLING GREEN KY
42101-6500
US

V. Phone/Fax

Practice location:
  • Phone: 304-690-6428
  • Fax:
Mailing address:
  • Phone: 304-690-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE LYNN GIBSON
Title or Position: OWNER
Credential: BCBA, LBA
Phone: 304-690-6428