Healthcare Provider Details

I. General information

NPI: 1457995979
Provider Name (Legal Business Name): HEATHER ANN GIBBENS LCSW, LMAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 4TH ST NE SUITE 1
DEVILS LAKE ND
58301
US

IV. Provider business mailing address

413 4TH ST NE SUITE 1
DEVILS LAKE ND
58301
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-3263
  • Fax:
Mailing address:
  • Phone: 701-665-3263
  • Fax: 701-868-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1868
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5866
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: