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General NPI Number Information
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NPI Number | 1154983104
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Entity Type | Individual
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Provider Name | JOSHUA LOGAN GIBSON BCBA
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Gender | Male
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Dates
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Enumeration Date | 06/30/2019
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 2600 MACARTHUR BLVD STE 302
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City | LEWISVILLE
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State | TX
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Zip | 75067-6751
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Country | US
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Telephone | 469-458-6832
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 MACARTHUR BLVD STE 302
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City | LEWISVILLE
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State | TX
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Zip | 75067-6751
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Country | US
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Telephone | 469-458-6832
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 8153
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License Number State | TX
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