Provider Demographics
NPI:1699494906
Name:GIBSON, ASHLEIGH (MA, LPC)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HERITAGE GREEN TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-2154
Mailing Address - Country:US
Mailing Address - Phone:405-226-5587
Mailing Address - Fax:
Practice Address - Street 1:3300 HERITAGE GREEN TRL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-2154
Practice Address - Country:US
Practice Address - Phone:405-226-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional