Healthcare Provider Details

I. General information

NPI: 1205126653
Provider Name (Legal Business Name): LEA ANN GIBSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 W 100 N
EPHRAIM UT
84627-2131
US

IV. Provider business mailing address

152 N 400 W
EPHRAIM UT
84627-5549
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-4065
  • Fax: 435-462-8407
Mailing address:
  • Phone: 435-283-8400
  • Fax: 435-283-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number70050273503
License Number StateUT

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: