Provider Demographics
NPI:1265972673
Name:GIPSON, CHRISTINA (BA COMMUNICATIONS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GIPSON
Suffix:
Gender:F
Credentials:BA COMMUNICATIONS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 DAYTONA DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6862
Mailing Address - Country:US
Mailing Address - Phone:307-871-2417
Mailing Address - Fax:
Practice Address - Street 1:3913 PEREGRINE ST
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-3490
Practice Address - Country:US
Practice Address - Phone:307-371-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator