Provider Demographics
NPI:1215480280
Name:GIBSON, KAREN (MS CLIN PSY)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS CLIN PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W 3RD AVE
Mailing Address - Street 2:#103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2236
Mailing Address - Country:US
Mailing Address - Phone:907-279-9627
Mailing Address - Fax:907-279-9632
Practice Address - Street 1:8012 STEWART MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9013
Practice Address - Country:US
Practice Address - Phone:907-279-9627
Practice Address - Fax:907-279-9632
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)