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General NPI Number Information
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NPI Number | 1396955621
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Entity Type | Individual
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Provider Name | MARY L GIBSON MA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 2275 E COOLEY DR
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City | COLTON
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State | CA
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Zip | 92324-6324
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Country | US
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Telephone | 909-370-1777
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Fax | 909-370-1776
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Provider Business Mailing Address
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Address Line | 1200 KENDALL DR APT 219
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4135
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Country | US
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Telephone | 909-567-7975
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Fax | 909-567-7975
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 119503
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License Number State | CA
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