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General NPI Number Information
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NPI Number | 1083276661
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Entity Type | Individual
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Provider Name | CONSTANCE E GIBSON LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 2015 CLAIRMONT CIR SW
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City | OLYMPIA
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State | WA
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Zip | 98512-5517
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Country | US
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Telephone | 707-322-8973
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11746
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City | OLYMPIA
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State | WA
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Zip | 98508-1746
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Country | US
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Telephone | 707-583-9287
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Fax | 707-466-7060
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT131974
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License Number State | CA
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