Provider Demographics
NPI:1831788611
Name:GIBBONS, GREGORY CECIL (LCSW)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:CECIL
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-539-8510
Mailing Address - Fax:940-432-3640
Practice Address - Street 1:1602 W BUSINESS 380 STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3267
Practice Address - Country:US
Practice Address - Phone:940-539-8510
Practice Address - Fax:940-432-3640
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8NX853OtherBCBS OF TEXAS
TX419691701Medicaid