1851471551 NPI number — MRS. LINDA LEE GIBSON MA LPC NCC

Table of content: MRS. LINDA LEE GIBSON MA LPC NCC (NPI 1851471551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851471551 NPI number — MRS. LINDA LEE GIBSON MA LPC NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBSON
Provider First Name:
LINDA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC NCC
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:
1851471551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2420 E COON LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-220-2787
Provider Business Mailing Address Fax Number:
810-220-2834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 GENOA BUSINESS PARK DR STE 180
Provider Second Line Business Practice Location Address:
ADVANCED COUNSELING SERVICES
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-220-2787
Provider Business Practice Location Address Fax Number:
810-220-2834
Provider Enumeration Date:
10/17/2006

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: 101YM0800X , with the licence number:  6401007052 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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