Provider Demographics
NPI:1851609408
Name:GIBSON, TINA LYNN (MS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LYNN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LYNN
Other - Last Name:GIBSON DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1101 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4919
Mailing Address - Country:US
Mailing Address - Phone:918-420-5006
Mailing Address - Fax:
Practice Address - Street 1:1101 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4919
Practice Address - Country:US
Practice Address - Phone:918-420-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health