Healthcare Provider Details

I. General information

NPI: 1992921860
Provider Name (Legal Business Name): FLORENCETTA GIBSON, CNS LMFT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DESIARD STREET SUITE 810
MONROE LA
71201
US

IV. Provider business mailing address

141 DESIARD STREET SUITE 810
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-8482
  • Fax:
Mailing address:
  • Phone: 318-322-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN036503 AP01392
License Number StateLA

VIII. Authorized Official

Name: FLORENCETTA GIBSON
Title or Position: OWNER
Credential:
Phone: 318-322-8482