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General NPI Number Information
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NPI Number | 1043920168
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Entity Type | Organization
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Legal Business Name | GIBSON FAMILY COUNSELING LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 5200 S YALE AVE STE 203
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City | TULSA
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State | OK
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Zip | 74135-7486
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Country | US
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Telephone | 918-607-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 26620 DUCK POND LN
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City | CLAREMORE
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State | OK
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Zip | 74019-7537
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Country | US
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Telephone | 918-607-0222
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | CARI DENISE GIBSON
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Credential | LPC
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Telephone | 918-607-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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