Provider Demographics
NPI:1922583434
Name:GIBSON, MARY CELESTE (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CELESTE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5665
Mailing Address - Country:US
Mailing Address - Phone:504-417-0152
Mailing Address - Fax:
Practice Address - Street 1:9938 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8193
Practice Address - Country:US
Practice Address - Phone:225-424-6800
Practice Address - Fax:225-424-2182
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health