Provider Demographics
NPI:1841644663
Name:GIBSON, KIMBERLY MARIE (BS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 KATELLA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3500
Mailing Address - Country:US
Mailing Address - Phone:714-309-0379
Mailing Address - Fax:888-975-4205
Practice Address - Street 1:4281 KATELLA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3500
Practice Address - Country:US
Practice Address - Phone:714-309-0379
Practice Address - Fax:888-975-4205
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health