Provider Demographics
NPI:1154690964
Name:GIBSON, DONALD CLYDE JR (LPC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:CLYDE
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2703
Mailing Address - Country:US
Mailing Address - Phone:719-377-7126
Mailing Address - Fax:719-544-2033
Practice Address - Street 1:1360 ALVESTON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2299
Practice Address - Country:US
Practice Address - Phone:719-360-4369
Practice Address - Fax:719-544-2033
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health