=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356170989
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DALE GIBSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2024
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 N PENNSYLVANIA ST STE B2
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-772-9518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6013 GIBSON RD
-----------------------------------------------------
City | BAKER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32531-8717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-772-9518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC.0022143
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------