Provider Demographics
NPI:1194576066
Name:GIBSON, HAROLD M & HAROLD (LPC)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:M & HAROLD
Last Name:GIBSON
Suffix:
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 1:1509 VILLAGE COURT CIR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6162
Mailing Address - Country:US
Mailing Address - Phone:195-675-5961
Mailing Address - Fax:
Practice Address - Street 1:1509 VILLAGE COURT CIR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6162
Practice Address - Country:US
Practice Address - Phone:956-755-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88553103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling