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General NPI Number Information
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NPI Number | 1023631652
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Entity Type | Individual
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Provider Name | GLORIA KAY GIBSON
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Gender | Female
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 1000 S MAIN ST STE 200
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City | GRAPEVINE
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State | TX
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Zip | 76051-7503
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Country | US
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Telephone | 972-945-7719
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Fax |
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Provider Business Mailing Address
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Address Line | 4202 LIBERTY CT
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3043
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Country | US
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Telephone | 972-945-7719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 78541
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License Number State | TX
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