Provider Demographics
NPI:1093331589
Name:GIBSON INSTITUTE OF COGNITIVE RESEARCH
Entity Type:Organization
Organization Name:GIBSON INSTITUTE OF COGNITIVE RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/RESEARCH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-213-1052
Mailing Address - Street 1:5085 LIST DR STE 200C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3301
Mailing Address - Country:US
Mailing Address - Phone:719-955-6716
Mailing Address - Fax:
Practice Address - Street 1:5085 LIST DR STE 200C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3301
Practice Address - Country:US
Practice Address - Phone:719-955-6716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch