Provider Demographics
NPI:1972033900
Name:GIBBONS, NIKKI (MA, LAMFT)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 158TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-7103
Mailing Address - Country:US
Mailing Address - Phone:612-655-8018
Mailing Address - Fax:
Practice Address - Street 1:3640 TALMAGE CIR STE 205
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55110-4183
Practice Address - Country:US
Practice Address - Phone:612-655-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist