Provider Demographics
NPI:1417780214
Name:GIBSON, AMY (CMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15047 S BUGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5722
Mailing Address - Country:US
Mailing Address - Phone:801-787-0033
Mailing Address - Fax:
Practice Address - Street 1:1218 W SOUTH JORDAN PKWY STE A2
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5946
Practice Address - Country:US
Practice Address - Phone:385-645-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health