Healthcare Provider Details

I. General information

NPI: 1326494410
Provider Name (Legal Business Name): KINYADA GIPSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 HIGHWAY 594
MONROE LA
71203-8005
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 318-737-7457
  • Fax: 318-737-7056
Mailing address:
  • Phone: 318-283-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5761
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: