Provider Demographics
NPI:1659108322
Name:TEX MARIE GIBSON LCSW PLLC
Entity type:Organization
Organization Name:TEX MARIE GIBSON LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEX
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-559-4297
Mailing Address - Street 1:54 NOLL ST APT 714
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5361
Mailing Address - Country:US
Mailing Address - Phone:817-559-4297
Mailing Address - Fax:
Practice Address - Street 1:110 LAFAYETTE ST RM 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4116
Practice Address - Country:US
Practice Address - Phone:817-559-4297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty