MEDICARE: CYRESIA GIBSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LAC5205	LA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1083086409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYRESIA GIBSON

Provider Business Mailing Address
First Line	:	20432 LULLABYE LN
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-4104
Country	:	US
Telephone Number	:	985-507-7684
Fax Number	:

Provider Business Practice Location Address
First Line	:	20432 LULLABYE LN
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70401-4104
Country	:	US
Telephone Number	:	985-507-7684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2015
Last Update Date	:	03/03/2026

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Directions to “ CYRESIA GIBSON ” Practice Location

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