Provider Demographics
NPI:1851686752
Name:GIBSON, LEMENTOUS D (MENTAL HEALTH COUNS)
Entity Type:Individual
Prefix:MRS
First Name:LEMENTOUS
Middle Name:D
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9962 S HILL TER APT 212
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9962 S HILL TER APT 212
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1258
Practice Address - Country:US
Practice Address - Phone:708-233-6685
Practice Address - Fax:708-233-0231
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health