| Doctor Name: | DR. MICHAEL JAY GIBSON |
| NPI Number: | 1144300872 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D |
| License Number: | 6401007904 |
| Business Practice Address: | 2012 10th St Menominee, MI - 498582194 |
| Business Phone Number: | 9068635646 |
| Business Fax Number: | 9068631078 |
| Mailing Address: | 1318 1st St Apt 8, MENOMINEE |
| State: | MI |
| Postal Code: | 498582861 |
| Phone Number: | 9068642454 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 02/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401007904 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |