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General NPI Number Information
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NPI Number | 1841798634
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Entity Type | Organization
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Legal Business Name | GPS PSYCHOLOGY & ANXIETY CLINIC, LLC
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 850 E FRANKLIN RD STE 404
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-258-7917
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Fax | 208-417-3088
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Provider Business Mailing Address
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Address Line | 850 E FRANKLIN RD STE 404
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City | MERIDIAN
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State | ID
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Zip | 83642-8917
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Country | US
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Telephone | 208-258-7917
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL PSYCHOLOGIST
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Name | DR. DANIEL GLEN GIBSON
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Credential | PSY.D., M.A., M.S.W
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Telephone | 208-258-7917
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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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