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General NPI Number Information
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NPI Number | 1831409440
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Entity Type | Organization
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Legal Business Name | CENTER FOR PSYCHOLOGICAL DEVELOPMENT, INC.
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1312 N 1ST AVE
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City | DURANT
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State | OK
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Zip | 74701-2810
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Country | US
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Telephone | 580-920-2069
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Fax | 580-920-1010
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Provider Business Mailing Address
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Address Line | 1312 N 1ST AVE
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City | DURANT
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State | OK
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Zip | 74701-2810
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Country | US
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Telephone | 580-920-2069
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Fax | 580-920-1010
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Authorized Official
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Title or Position | CEO/CO-OWNER
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Name | MR. STACEY L GIBSON
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Credential | MBS, LPC-S
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Telephone | 580-920-2069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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