Provider Demographics
NPI:1821413550
Name:GIBSON, SUSAN DAWN (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DAWN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:110 S 5TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2661
Mailing Address - Country:US
Mailing Address - Phone:405-556-0478
Mailing Address - Fax:
Practice Address - Street 1:110 S 5TH ST STE 108
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2661
Practice Address - Country:US
Practice Address - Phone:405-556-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK7503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health