Provider Demographics
NPI:1669688321
Name:GIBSON, GOSBY (LMHC)
Entity Type:Individual
Prefix:MR
First Name:GOSBY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 UNIVERSITY BLVD # 167
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1904
Mailing Address - Country:US
Mailing Address - Phone:407-765-4397
Mailing Address - Fax:
Practice Address - Street 1:100 E SYBELIA AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4763
Practice Address - Country:US
Practice Address - Phone:407-765-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
FLMH 7651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)