Provider Demographics
NPI:1154983104
Name:GIBSON, JOSHUA LOGAN (BCBA)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LOGAN
Last Name:GIBSON
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:J. LOGAN
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCBA
Mailing Address - Street 1:2600 MACARTHUR BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6751
Mailing Address - Country:US
Mailing Address - Phone:469-458-6832
Mailing Address - Fax:
Practice Address - Street 1:2600 MACARTHUR BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6751
Practice Address - Country:US
Practice Address - Phone:469-458-6832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8153103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty