MEDICARE: MRS. RACHEL M. GIBSON L.P.C.

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	101YP2500X	Professional Counselor	61947	TX

General Provider Information

NPI Number	:	1275728941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL M. GIBSON L.P.C.

Provider Business Mailing Address
First Line	:	445 E FM 1382 STE 3-184
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-6047
Country	:	US
Telephone Number	:	972-998-1643
Fax Number	:	972-274-2526

Provider Business Practice Location Address
First Line	:	1107 NOBLEWOOD DR
Second Line	:
City	:	GLENN HEIGHTS
State	:	TX
Zip	:	75154-8769
Country	:	US
Telephone Number	:	972-998-1643
Fax Number	:	972-274-2526

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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