Provider Demographics
NPI:1033648795
Name:GIPSON, DALLAS RAY (LPC)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:RAY
Last Name:GIPSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DALLAS
Other - Middle Name:RAY
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1819
Mailing Address - Country:US
Mailing Address - Phone:417-327-2273
Mailing Address - Fax:
Practice Address - Street 1:1700 E 72ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1819
Practice Address - Country:US
Practice Address - Phone:417-327-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016018770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490043149Medicaid