Provider Demographics
NPI:1386055408
Name:GIBSON, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W EASTMAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5937
Mailing Address - Country:US
Mailing Address - Phone:847-873-1505
Mailing Address - Fax:847-221-8285
Practice Address - Street 1:120 W EASTMAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5937
Practice Address - Country:US
Practice Address - Phone:847-873-1505
Practice Address - Fax:847-221-8285
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst