Individual
ERIC KEVEN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NO
Contact information
Practice address
4301 BUFFALO TRL, EVANS, CO 80620-9454
(310) 877-0774
Mailing address
4301 BUFFALO TRL, EVANS, CO 80620-9454
(310) 877-0774
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2137347793
—
CO
Enumeration date
03/07/2019
Last updated
03/07/2019
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