MEDICARE: JANET IRENE GIBSON LMFT

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	101YM0800X	Mental Health Counselor	MH8748	FL
2	106H00000X	Marriage & Family Therapist	MT 2498	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z00K3	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871651125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET IRENE GIBSON LMFT

Provider Business Mailing Address
First Line	:	555 ROUND ROCK WEST DR
Second Line	:	SUITE E232
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5052
Country	:	US
Telephone Number	:	512-677-4183
Fax Number	:	866-617-5633

Provider Business Practice Location Address
First Line	:	555 ROUND ROCK WEST DR
Second Line	:	SUITE E232
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5052
Country	:	US
Telephone Number	:	512-677-4183
Fax Number	:	866-617-5633

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	10/14/2013

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Directions to “ JANET IRENE GIBSON LMFT” Practice Location

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