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NPI Code Detail

MEDICARE: GIBSON CENTER FOR BEHAVIORAL CHANGE

MEDICARE: GIBSON CENTER FOR BEHAVIORAL CHANGE
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
1324500000XSubstance Abuse Rehabilitation Facility30567335MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2105152OTHERMOBLUE CROSSBLUE SHIELD

General Provider Information

NPI Number : 1184774275
Entity Type Code : Organization
Provider Name (Legal Business Name) : GIBSON CENTER FOR BEHAVIORAL CHANGE
Provider Business Mailing Address
First Line : PO BOX 1267
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63702-1267
Country : US
Telephone Number : 573-332-0416
Fax Number : 573-334-0312
Provider Business Practice Location Address
First Line : 1112 LINDEN ST
Second Line :
City : CAPE GIRARDEAU
State : MO
Zip : 63703-7707
Country : US
Telephone Number : 573-332-0416
Fax Number : 573-334-0312
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : RYAN ESSEX
Credential :
Telephone Number : 573-803-4145
Provider Enumeration Date : 01/11/2007
Last Update Date : 01/31/2024

Similar Medicare Providers

1407148364 — MR. TERRY LYNN SHIRLEY LCSW
Practice Location Address:
1112 LINDEN ST
CAPE GIRARDEAU, MO
63703-7707
Practice Phone: 573-334-5513
Practice Fax: 573-334-0312
1295243384 — BRITTANY JAMES RN
Practice Location Address:
1112 LINDEN ST
CAPE GIRARDEAU, MO
63703-7707
Practice Phone: 573-332-0416
Practice Fax: 573-335-2698
1629576111 — HANNAH COX LPN
Practice Location Address:
1112 LINDEN ST
CAPE GIRARDEAU, MO
63703-7707
Practice Phone: 573-332-0416
Practice Fax: 573-335-2698
1336647833 — MACY TATUM LPN
Practice Location Address:
1112 LINDEN ST
CAPE GIRARDEAU, MO
63703-7707
Practice Phone: 573-332-0416
Practice Fax: 573-335-2698
1215435706 — MIRANDA LANDRETH LPN
Practice Location Address:
1112 LINDEN ST
CAPE GIRARDEAU, MO
63703-7707
Practice Phone: 573-332-0416
Practice Fax: 573-335-2698
1154829596 — MARY HILL RN
Practice Location Address:
1112 LINDEN ST
CAPE GIRARDEAU, MO
63703-7707
Practice Phone: 573-332-0416
Practice Fax: 573-335-2698

Directions to “GIBSON CENTER FOR BEHAVIORAL CHANGE ” Practice Location

Language Start Address Practice Location
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