Provider Demographics
NPI:1093367724
Name:GIBSON, WILLIAM M (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:GIBSON
Suffix:
Gender:M
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14657 SIVERTSON RD NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3051
Mailing Address - Country:US
Mailing Address - Phone:206-465-9935
Mailing Address - Fax:
Practice Address - Street 1:14657 SIVERTSON RD NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3051
Practice Address - Country:US
Practice Address - Phone:206-465-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60916349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health