Provider Demographics
NPI:1700509536
Name:GIBSON, PIPER N (AHND, TND, DFM)
Entity Type:Individual
Prefix:
First Name:PIPER
Middle Name:N
Last Name:GIBSON
Suffix:
Gender:F
Credentials:AHND, TND, DFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 ONEIDA DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-0856
Mailing Address - Country:US
Mailing Address - Phone:575-496-6113
Mailing Address - Fax:
Practice Address - Street 1:3850 FOOTHILLS RD STE 9
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4632
Practice Address - Country:US
Practice Address - Phone:575-323-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPWA-4543412101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral