Provider Demographics
NPI:1437501012
Name:MISTY GIBSON
Entity Type:Organization
Organization Name:MISTY GIBSON
Other - Org Name:HANA LOKAHI THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-499-2500
Mailing Address - Street 1:685 SPRING ST STE 5020
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8058
Mailing Address - Country:US
Mailing Address - Phone:360-499-2500
Mailing Address - Fax:
Practice Address - Street 1:685 SPRING ST STE 5020
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8058
Practice Address - Country:US
Practice Address - Phone:360-499-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty