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General NPI Number Information
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NPI Number | 1336958735
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Entity Type | Organization
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Legal Business Name | GIBSON VENTURES, LLC
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 1218 W SOUTH JORDAN PKWY STE A2
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5946
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Country | US
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Telephone | 385-645-8889
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Fax |
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Provider Business Mailing Address
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Address Line | 15047 S BUGLE RIDGE DR
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City | HERRIMAN
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State | UT
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Zip | 84096-5722
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Country | US
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Telephone | 801-735-7555
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | BRAD GIBSON
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Credential |
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Telephone | 801-735-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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