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General NPI Number Information
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NPI Number | 1497399414
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Entity Type | Organization
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Legal Business Name | GOOD VIBES COUNSELING SERVICES
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 2002 MADISON 417
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-7002
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Country | US
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Telephone | 573-944-1946
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 MADISON 417
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City | FREDERICKTOWN
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State | MO
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Zip | 63645-7002
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Country | US
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Telephone | 573-944-1946
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Fax |
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | ROBIN LEA GIPSON
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Credential | MSW LCSW
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Telephone | 573-944-1946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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