Provider Demographics
NPI:1063113652
Name:GIBSON, CHRIS ALLEN (MS, D MIN, LPC)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:ALLEN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MS, D MIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9299 ROCKY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6518
Mailing Address - Country:US
Mailing Address - Phone:601-668-5331
Mailing Address - Fax:
Practice Address - Street 1:9299 ROCKY WOODS DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6518
Practice Address - Country:US
Practice Address - Phone:601-668-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional