Provider Demographics
NPI:1225369408
Name:GIBSON, JANELLE JONES (LCSW)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:JONES
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N COIT RD STE 1175
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5550
Mailing Address - Country:US
Mailing Address - Phone:469-608-9484
Mailing Address - Fax:
Practice Address - Street 1:300 N COIT RD STE 1175
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5550
Practice Address - Country:US
Practice Address - Phone:469-608-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30019OtherLICENSE