Doctor Name: | CONNIE FRANCIS GIBSON |
NPI Number: | 1003180340 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 10313 Sw 69th Ave Tigard, OR - 972239103 |
Business Phone Number: | 5037263740 |
Business Fax Number: | 5037263741 |
Mailing Address: | 10313 Sw 69th Ave, TIGARD |
State: | OR |
Postal Code: | 972239103 |
Phone Number: | 5037263740 |
Fax Number: | 5037263741 |
NPI Enumeration Date: | 03/05/2012 |
NPI Last Update Date: | 03/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TB0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Cognitive & Behavioral |
Taxonomy Definition: |