Provider Demographics
NPI:1447602248
Name:FRANKS GIBSON, ALICIA K (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:K
Last Name:FRANKS GIBSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:K
Other - Last Name:BALCERZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:4830 S RICHFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1838
Mailing Address - Country:US
Mailing Address - Phone:303-946-4369
Mailing Address - Fax:
Practice Address - Street 1:2840 NW 2ND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6694
Practice Address - Country:US
Practice Address - Phone:800-233-5976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0461508103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool