Basic Information
| Provider Information | |||||||||
| NPI: | 1467651067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GIBSON COUNSELING SERVICES, INC, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5775 | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 734030775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804909192 | ||||||||
| FaxNumber: | 5804909194 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 B ST SW | ||||||||
| Address2: | |||||||||
| City: | ARDMORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 734016418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804909192 | ||||||||
| FaxNumber: | 5804909194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 07/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | GIBSON | ||||||||
| AuthorizedOfficialFirstName: | MYRIA | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5804909192 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.S. LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2638 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.