Provider Demographics
NPI:1609962273
Name:GIBBON, JADE D (LPC)
Entity Type:Individual
Prefix:MR
First Name:JADE
Middle Name:D
Last Name:GIBBON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 W. KENTUCKY DR.
Mailing Address - Street 2:APT. E
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4449
Mailing Address - Country:US
Mailing Address - Phone:303-716-2566
Mailing Address - Fax:
Practice Address - Street 1:7177 W. KENTUCKY DR.
Practice Address - Street 2:APT. E
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4449
Practice Address - Country:US
Practice Address - Phone:303-716-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4040101YM0800X
TX12796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health