Provider Demographics
NPI:1386428142
Name:SUSAN DAWN GIBSON, LLC
Entity type:Organization
Organization Name:SUSAN DAWN GIBSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-556-0478
Mailing Address - Street 1:110 S 5TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2661
Mailing Address - Country:US
Mailing Address - Phone:405-556-0478
Mailing Address - Fax:
Practice Address - Street 1:110 S 5TH ST STE 108
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2661
Practice Address - Country:US
Practice Address - Phone:405-556-0478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2024-06-04
Deactivation Date:2024-04-25
Deactivation Code:
Reactivation Date:2024-06-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty