Provider Demographics
NPI:1982981106
Name:GIBSON, JOANINE MARIE
Entity Type:Individual
Prefix:
First Name:JOANINE
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N HOPE ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5228
Mailing Address - Country:US
Mailing Address - Phone:580-275-9412
Mailing Address - Fax:
Practice Address - Street 1:229 N HOPE ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5228
Practice Address - Country:US
Practice Address - Phone:580-275-9412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health