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General NPI Number Information
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NPI Number | 1639973670
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Entity Type | Individual
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Provider Name | MICHAEL CORTLAND GIPSON LMSW
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Gender | Male
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 7165 COLLEYVILLE BLVD
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City | COLLEYVILLE
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State | TX
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Zip | 76034-8008
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Country | US
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Telephone | 817-847-8169
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Fax |
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Provider Business Mailing Address
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Address Line | 3951 DECHMAN DR APT 3206
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-6861
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Country | US
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Telephone | 469-755-0394
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 109220
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License Number State | TX
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