Provider Demographics
NPI:1922525997
Name:GIBSON, ANGELA L (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 TAMAYO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5283
Mailing Address - Country:US
Mailing Address - Phone:713-232-0037
Mailing Address - Fax:281-277-7261
Practice Address - Street 1:2646 S LOOP W STE 505F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2869
Practice Address - Country:US
Practice Address - Phone:713-232-0037
Practice Address - Fax:281-277-7261
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional