Provider Demographics
NPI:1902232028
Name:GIBSON, MELISSA (MS, CFLE)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-5743
Mailing Address - Country:US
Mailing Address - Phone:417-812-6302
Mailing Address - Fax:
Practice Address - Street 1:230 N BELCREST AVE STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6287
Practice Address - Country:US
Practice Address - Phone:417-413-4676
Practice Address - Fax:417-763-3308
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor