Provider Demographics
NPI:1194864223
Name:GIBSON, JUDITH (MASTER OF ARTS MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MASTER OF ARTS MA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:M
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTER OF ARTS MA
Mailing Address - Street 1:1045 N 41ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-2113
Mailing Address - Country:US
Mailing Address - Phone:402-466-6263
Mailing Address - Fax:
Practice Address - Street 1:1045 N 41ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-2113
Practice Address - Country:US
Practice Address - Phone:402-466-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE628101YM0800X
NE214101YM0800X
NE549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
10181OtherMIDLANDS CHOICE
NE371093OtherMHN MNGEDHEALTH NETWORK
NE84939OtherBLUE CROSS BLUE SHIELD
NE6246121OtherUNITED BEHAVIORAL HEALTH