Provider Demographics
NPI:1083276661
Name:GIBSON, CONSTANCE E (LMFT)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:E
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11746
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1746
Mailing Address - Country:US
Mailing Address - Phone:707-583-9287
Mailing Address - Fax:707-466-7060
Practice Address - Street 1:2015 CLAIRMONT CIR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5517
Practice Address - Country:US
Practice Address - Phone:707-322-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT131974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist