Basic Information
| Provider Information | |||||||||
| NPI: | 1497958722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | GEOFF | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23070 | ||||||||
| Address2: | |||||||||
| City: | BARLING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729230070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794525040 | ||||||||
| FaxNumber: | 4794525047 | ||||||||
| Practice Location | |||||||||
| Address1: | 1340 S WALDRON RD | ||||||||
| Address2: | STE #2 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729032556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794525040 | ||||||||
| FaxNumber: | 4794525047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 829 | OK | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | M0907004 | AR | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.