Healthcare Provider Details

I. General information

NPI: 1255023982
Provider Name (Legal Business Name): GIBSON PSYCH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SINGLETREE LN STE 312
EDEN PRAIRIE MN
55344-5398
US

IV. Provider business mailing address

11800 SINGLETREE LN STE 312
EDEN PRAIRIE MN
55344-5398
US

V. Phone/Fax

Practice location:
  • Phone: 612-440-6557
  • Fax: 612-500-4964
Mailing address:
  • Phone: 612-440-6557
  • Fax: 612-500-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOAN GIBSON
Title or Position: APRN, PSYCHIATRIC CNS
Credential:
Phone: 612-242-9532