Individual
JIMMY R. GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
302 N MAIN ST, CARLSBAD, NM 88220-5896
(575) 885-0956
(575) 234-9854
Mailing address
914 N CANAL ST, CARLSBAD, NM 88220-5110
(575) 885-4836
(575) 628-0676
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
1544
KY
1041C0700X
Clinical Social Worker
Primary
X-07673
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000375385
ANTHEM BC/BS
KY
01
—
1164437
CHA HEALTH
KY
01
—
611549000
ACS-DEPT OF LABOR
KY
Enumeration date
10/11/2006
Last updated
03/27/2012
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