Provider Demographics
NPI:1710262258
Name:GIBSON, ELBERT JERRY (BHRS)
Entity Type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:JERRY
Last Name:GIBSON
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7907
Mailing Address - Country:US
Mailing Address - Phone:405-848-2171
Mailing Address - Fax:405-848-2078
Practice Address - Street 1:301 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7907
Practice Address - Country:US
Practice Address - Phone:405-848-2171
Practice Address - Fax:405-848-2078
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst