Organization
GIBSON CENTER FOR BEHAVIORAL CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN ESSEX (CHIEF OPERATING OFFICER)
(573) 803-4145
Entity
Organization
Contact information
Practice address
1112 LINDEN ST, CAPE GIRARDEAU, MO 63703-7707
(573) 332-0416
(573) 334-0312
Mailing address
PO BOX 1267, CAPE GIRARDEAU, MO 63702-1267
(573) 332-0416
(573) 334-0312
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
30567335
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105152
BLUE CROSSBLUE SHIELD
MO
05
—
863112702
—
MO
Enumeration date
01/11/2007
Last updated
01/31/2024
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