Provider Demographics
NPI:1205415296
Name:GIBSON, LAUREN HOPE (LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:HOPE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 WILLIAMS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1335
Mailing Address - Country:US
Mailing Address - Phone:512-651-1009
Mailing Address - Fax:
Practice Address - Street 1:4118 WILLIAMS DR STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1335
Practice Address - Country:US
Practice Address - Phone:512-651-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123610106H00000X
TX204136101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist