Individual
MR. PHILIP JOHN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA,LLP
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 802-4456
(616) 336-4333
Mailing address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 802-4456
(616) 336-4333
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
6301011584
MI
Other
Enumeration date
12/07/2018
Last updated
12/07/2018
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