Provider Demographics
NPI:1144696147
Name:GIBSON, LISA (LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11966 COUNTY ROAD I
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-1704
Mailing Address - Country:US
Mailing Address - Phone:806-669-9402
Mailing Address - Fax:
Practice Address - Street 1:11966 COUNTY ROAD I
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-1704
Practice Address - Country:US
Practice Address - Phone:806-440-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70319101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional