Provider Demographics
NPI:1740225606
Name:GIBSON, DEBRA ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ELAINE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ELAINE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1900 N OSAGE ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1144
Mailing Address - Country:US
Mailing Address - Phone:580-762-1812
Mailing Address - Fax:
Practice Address - Street 1:1500 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2827
Practice Address - Country:US
Practice Address - Phone:580-762-7561
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health