Individual
STEPHEN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
850 E FRANKLIN RD STE 402, MERIDIAN, ID 83642-8917
(208) 258-7917
Mailing address
850 E FRANKLIN RD STE 402, MERIDIAN, ID 83642-8917
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
Other
Enumeration date
12/06/2022
Last updated
12/11/2024
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