Provider Demographics
NPI:1841886181
Name:GIPSON, LEAH (LCPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GIPSON
Suffix:
Gender:F
Credentials:LCPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LARAMIE CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6631
Mailing Address - Country:US
Mailing Address - Phone:708-567-5436
Mailing Address - Fax:
Practice Address - Street 1:101 LARAMIE CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-6631
Practice Address - Country:US
Practice Address - Phone:708-567-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional