Provider Demographics
NPI:1174272132
Name:GIPSON, ELIZABETH JO (LPCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JO
Last Name:GIPSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4632 KENTUCKY 1043
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175
Mailing Address - Country:US
Mailing Address - Phone:606-498-4175
Mailing Address - Fax:
Practice Address - Street 1:4632 KENTUCKY 1043
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175
Practice Address - Country:US
Practice Address - Phone:606-498-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional