Provider Demographics
NPI:1396116729
Name:GIBSON, MISTY (PHD, LMHC, LCPC)
Entity type:Individual
Prefix:DR
First Name:MISTY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:PHD, LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600B SW DASH POINT RD # 1017
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-4530
Mailing Address - Country:US
Mailing Address - Phone:253-201-2436
Mailing Address - Fax:
Practice Address - Street 1:1600B SW DASH POINT RD # 1017
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-4530
Practice Address - Country:US
Practice Address - Phone:253-201-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60819101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional