=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114601820
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN MAXINE GIBSON LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2023
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1483 W MAIN ST
-----------------------------------------------------
City | TIPP CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45371-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-584-5123
-----------------------------------------------------
Fax | 567-890-7214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 E. MARKET ST.
-----------------------------------------------------
City | CELINA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45822-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-335-0361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S.2309410
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------