Provider Demographics
NPI:1649715962
Name:GIBSON, TROY ELDON JR (MA, LCPC)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:ELDON
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 N LAKE SHORE DR APT 625E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6447
Mailing Address - Country:US
Mailing Address - Phone:484-632-9643
Mailing Address - Fax:
Practice Address - Street 1:3950 N LAKE SHORE DR APT 625E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6447
Practice Address - Country:US
Practice Address - Phone:484-632-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012601101YM0800X
IL180012507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health