Provider Demographics
NPI:1356640569
Name:GIPSON, MARY NEAL (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:NEAL
Last Name:GIPSON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MS
Other - First Name:EMILYN
Other - Middle Name:N
Other - Last Name:GIPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:219 S. 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:OPEIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801
Mailing Address - Country:US
Mailing Address - Phone:334-749-0201
Mailing Address - Fax:334-749-2818
Practice Address - Street 1:218 S. 8TH ST.
Practice Address - Street 2:
Practice Address - City:OPEIKA
Practice Address - State:AL
Practice Address - Zip Code:36801
Practice Address - Country:US
Practice Address - Phone:334-749-0201
Practice Address - Fax:334-749-2818
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLMFT186106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist