Provider Demographics
NPI:1043452246
Name:GIBBONS DOXEY, MYRLA CAROLYN (MA LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MYRLA
Middle Name:CAROLYN
Last Name:GIBBONS DOXEY
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5467 UPPER MOUNTAIN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1895
Mailing Address - Country:US
Mailing Address - Phone:716-439-7412
Mailing Address - Fax:716-439-7418
Practice Address - Street 1:5467 UPPER MOUNTAIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1895
Practice Address - Country:US
Practice Address - Phone:716-439-7412
Practice Address - Fax:716-439-7418
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist