Provider Demographics
NPI:1033288055
Name:GIBSON, PATRICK ROBERT (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ROBERT
Last Name:GIBSON
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-2044
Mailing Address - Country:US
Mailing Address - Phone:817-451-3380
Mailing Address - Fax:817-451-1331
Practice Address - Street 1:1020 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1527
Practice Address - Country:US
Practice Address - Phone:214-743-1200
Practice Address - Fax:817-451-1331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health