Provider Demographics
NPI:1891788170
Name:GIBSON, RANDALL CHARLES (LPC)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:CHARLES
Last Name:GIBSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3929 WEEBURN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-2719
Mailing Address - Country:US
Mailing Address - Phone:214-929-4670
Mailing Address - Fax:972-934-8115
Practice Address - Street 1:5710 LBJ FWY
Practice Address - Street 2:STE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6324
Practice Address - Country:US
Practice Address - Phone:214-929-4670
Practice Address - Fax:972-934-8115
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional