Provider Demographics
NPI:1427416387
Name:GIBSON, PAUL K (MC, LMFT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:K
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 S RURAL RD STE 112
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5500
Mailing Address - Country:US
Mailing Address - Phone:480-428-2944
Mailing Address - Fax:480-680-5361
Practice Address - Street 1:3920 S RURAL RD STE 112
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5500
Practice Address - Country:US
Practice Address - Phone:480-428-2944
Practice Address - Fax:480-680-5361
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-10254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ346214Medicaid