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General NPI Number Information
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NPI Number | 1467651067
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Entity Type | Organization
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Legal Business Name | GIBSON COUNSELING SERVICES, INC, PC
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Dates
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Enumeration Date | 07/13/2007
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 27 B ST SW
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City | ARDMORE
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State | OK
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Zip | 73401-6418
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Country | US
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Telephone | 580-490-9192
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Fax | 580-490-9194
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Provider Business Mailing Address
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Address Line | PO BOX 5775
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City | ARDMORE
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State | OK
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Zip | 73403-0775
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Country | US
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Telephone | 580-490-9192
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Fax | 580-490-9194
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MYRIA E. GIBSON
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Credential | M.S. LPC
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Telephone | 580-490-9192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2638
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License Number State | OK
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