Provider Demographics
NPI:1174272132
Name:GIPSON, ELIZABETH JO (LPC-S)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JO
Last Name:GIPSON
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1126
Mailing Address - Country:US
Mailing Address - Phone:606-465-8912
Mailing Address - Fax:
Practice Address - Street 1:225 W EMMITT AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1075
Practice Address - Country:US
Practice Address - Phone:740-912-2433
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2404038-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0026650Medicaid