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General NPI Number Information
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NPI Number | 1750044434
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Entity Type | Individual
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Provider Name | CARLI CHARISSE GIBSON LPC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 622 HEMPHILL ST
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City | FORT WORTH
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State | TX
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Zip | 76104-3179
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Country | US
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Telephone | 214-621-4227
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Fax |
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Provider Business Mailing Address
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Address Line | 622 HEMPHILL ST
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City | FORT WORTH
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State | TX
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Zip | 76104-3179
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 82038
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License Number State | TX
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