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General NPI Number Information
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NPI Number | 1043543465
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Entity Type | Individual
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Provider Name | MICHAEL WAYNE GIBSON M. ED.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 4625 NORTH FWY
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City | HOUSTON
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State | TX
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Zip | 77022-2914
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Country | US
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Telephone | 713-697-0776
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Fax | 713-697-2309
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Provider Business Mailing Address
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Address Line | 5415 BRIAN HAVEN DR
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City | HOUSTON
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State | TX
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Zip | 77091-5503
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Country | US
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Telephone | 713-688-1811
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Fax | 713-688-1911
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7635
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License Number State | TX
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