Basic Information
| Provider Information | |||||||||
| NPI: | 1114262805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | PATSY | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | B.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 W I 240 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056353868 | ||||||||
| FaxNumber: | 4056049689 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W I 240 SERVICE RD. | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731397701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056353868 | ||||||||
| FaxNumber: | 4056049689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.