Healthcare Provider Details

I. General information

NPI: 1528511672
Provider Name (Legal Business Name): DUSTEE GIBSON MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N STATE ST
STANTON MI
48888-9702
US

IV. Provider business mailing address

611 N STATE ST
STANTON MI
48888-9702
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: