Provider Demographics
NPI:1275702342
Name:GIBSON, ADRIENNE M (MA LPC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14025 SW FARMINGTON RD # 160
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2512
Mailing Address - Country:US
Mailing Address - Phone:503-258-4498
Mailing Address - Fax:
Practice Address - Street 1:323 NE 80TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-7017
Practice Address - Country:US
Practice Address - Phone:480-296-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12876101YP2500X
ORC3446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional