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General NPI Number Information
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NPI Number | 1811931850
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Entity Type | Individual
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Provider Name | SCOTT GIBSON SR.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 2015 MAXWELL AVE
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City | EVANSVILLE
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State | IN
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Zip | 47711-4359
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Country | US
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Telephone | 812-422-7974
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Fax | 812-671-0627
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Provider Business Mailing Address
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Address Line | 2015 MAXWELL AVE
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City | EVANSVILLE
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State | IN
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Zip | 47711-4359
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Country | US
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Telephone | 812-422-7974
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Fax | 812-671-0627
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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 | 39000754A
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License Number State | IN
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