Provider Demographics
NPI:1467651067
Name:GIBSON COUNSELING SERVICES, INC, PC
Entity Type:Organization
Organization Name:GIBSON COUNSELING SERVICES, INC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:580-490-9192
Mailing Address - Street 1:PO BOX 5775
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73403-0775
Mailing Address - Country:US
Mailing Address - Phone:580-490-9192
Mailing Address - Fax:580-490-9194
Practice Address - Street 1:27 B ST SW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6418
Practice Address - Country:US
Practice Address - Phone:580-490-9192
Practice Address - Fax:580-490-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty