Provider Demographics
NPI:1740738731
Name:GIBSON INSTITUTE OF COGNITIVE RESEARCH
Entity Type:Organization
Organization Name:GIBSON INSTITUTE OF COGNITIVE RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-219-0940
Mailing Address - Street 1:5085 LIST DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3345
Mailing Address - Country:US
Mailing Address - Phone:719-219-0940
Mailing Address - Fax:
Practice Address - Street 1:5085 LIST DR
Practice Address - Street 2:SUITE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3345
Practice Address - Country:US
Practice Address - Phone:719-219-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch