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General NPI Number Information
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NPI Number | 1871354563
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Entity Type | Individual
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Provider Name | ELIZABETH D GIBBENS PLMHP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 815 LAKE AVE
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City | GOTHENBURG
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State | NE
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Zip | 69138-1943
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Country | US
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Telephone | 308-537-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 714 E 17TH ST
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City | COZAD
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State | NE
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Zip | 69130-1666
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Country | US
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Telephone | 308-746-2230
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13768
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License Number State | NE
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