Provider Demographics
NPI:1699384818
Name:GIBSON, KRISTEN (LADC LPCC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LADC LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1029
Mailing Address - Country:US
Mailing Address - Phone:612-594-2007
Mailing Address - Fax:
Practice Address - Street 1:510 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1029
Practice Address - Country:US
Practice Address - Phone:612-594-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304908101YA0400X
MNCC02840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)