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General NPI Number Information
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NPI Number | 1124429766
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Entity Type | Individual
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Provider Name | SCOTT ANTHONY GIBSON M.A.
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Gender | Male
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 805 COMMERCE DR
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City | LEITCHFIELD
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State | KY
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Zip | 42754
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Country | US
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Telephone | 270-765-5817
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Fax |
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Provider Business Mailing Address
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Address Line | 207 FAIRGROUNDS RD
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City | HARDINSBURG
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State | KY
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Zip | 40143-2585
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Country | US
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Telephone | 270-765-5817
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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