Provider Demographics
NPI:1831556091
Name:FRANCISCOTTY, MARIO GIBSON (LLPC)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:GIBSON
Last Name:FRANCISCOTTY
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 EGYPT VALLEY CT NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9660
Mailing Address - Country:US
Mailing Address - Phone:616-295-0691
Mailing Address - Fax:
Practice Address - Street 1:6200 EGYPT VALLEY CT NE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9660
Practice Address - Country:US
Practice Address - Phone:616-295-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010137101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor