Provider Demographics
NPI:1467408815
Name:GIBSON, WILLIAM THOMAS (NP, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:GIBSON
Suffix:
Gender:M
Credentials:NP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SE WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99111
Mailing Address - Country:US
Mailing Address - Phone:509-335-3575
Mailing Address - Fax:509-336-7389
Practice Address - Street 1:1125 SE WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99111
Practice Address - Country:US
Practice Address - Phone:509-335-3575
Practice Address - Fax:509-336-7389
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005329103T00000X, 363LP0808X
PY12342713103T00000X
WAPY00002713103TB0200X
IDCNS-11A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCNS-11AOtherIDAHO STATE LICENSE
WARN00132277OtherWA LICENSE
WAAP30005329OtherWA LICENSE
WAAP30005329OtherWA LICENSE