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General NPI Number Information
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NPI Number | 1871300574
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Entity Type | Organization
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Legal Business Name | LAURA GIBBS COUNSELING, PLLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 4507 N STERLING AVE STE 208A
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City | PEORIA
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State | IL
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Zip | 61615-3817
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Country | US
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Telephone | 309-863-5129
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Fax |
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Provider Business Mailing Address
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Address Line | 505 N PINE ST
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City | WILLIAMSFIELD
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State | IL
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Zip | 61489-9517
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Country | US
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Telephone | 309-337-5999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA M GIBBS
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Credential | MA, LCPC
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Telephone | 309-863-5129
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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 |
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License Number State |
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