Provider Demographics
NPI:1245562388
Name:GIBSON, KRISTIN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:KRISTI
Other - Middle Name:
Other - Last Name:BJORKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1100 NE 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1099
Mailing Address - Country:US
Mailing Address - Phone:405-271-5700
Mailing Address - Fax:405-271-8835
Practice Address - Street 1:1100 NE 13TH STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1099
Practice Address - Country:US
Practice Address - Phone:405-271-5700
Practice Address - Fax:405-271-8835
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-30
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK4507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4507OtherOKLAHOMA STATE LICENSE NUMBER