1366141392 NPI number — MRS. KELSEY WILLIAMS GIBBS LCSW

Table of content: MRS. KELSEY WILLIAMS GIBBS LCSW (NPI 1366141392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366141392 NPI number — MRS. KELSEY WILLIAMS GIBBS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBS
Provider First Name:
KELSEY
Provider Middle Name:
WILLIAMS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366141392
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9112 NATHANIEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBREY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76227-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-433-0299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S LOCUST ST STE 602
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-6159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-956-6463
Provider Business Practice Location Address Fax Number:
866-653-5142
Provider Enumeration Date:
02/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  109391 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109391 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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