MEDICARE: MS. NICOLE GIBSON B.S.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101Y00000X	Counselor	LA
2	171M00000X	Case Manager/Care Coordinator	LA
3	101YM0800X	Mental Health Counselor	LA

General Provider Information

NPI Number	:	1538532106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE GIBSON B.S.

Provider Business Mailing Address
First Line	:	315 S COLLEGE RD STE 100
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3213
Country	:	US
Telephone Number	:	337-205-6073
Fax Number	:	337-264-9282

Provider Business Practice Location Address
First Line	:	315 S COLLEGE RD STE 100
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3213
Country	:	US
Telephone Number	:	337-205-6073
Fax Number	:	337-264-9282

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

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	09/19/2025

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