Provider Demographics
NPI:1518152644
Name:GIBSON, DANNY R (MFT)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:R
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:DANNY
Other - Middle Name:R
Other - Last Name:GIBSON-WEINBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:510 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1912
Mailing Address - Country:US
Mailing Address - Phone:323-480-3997
Mailing Address - Fax:
Practice Address - Street 1:554 SO. SAN VICENTE BLVD. SUITE # 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048
Practice Address - Country:US
Practice Address - Phone:323-744-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist