# JERRY DEAN GISON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215435029
- **Authorized official:** JERRY GIBSON (OWNER)
- **Authorized official phone:** (276) 698-8722

## Contact information

- **Practice address:** 125 BROOKDALE DR STE 125, MORGANTOWN, WV 26508-8799
- **Practice address phone:** (304) 241-1108
- **Mailing address:** 125 BROOKDALE DR STE 125, MORGANTOWN, WV 26508-8799
- **Mailing address phone:** (304) 241-1108

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | Yes |
| 101YP2500X | Professional Counselor | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2018
- **Last updated:** 01/26/2018