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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
340 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5703
(573) 332-0416
Mailing address
PO BOX 1267, CAPE GIRARDEAU, MO 63702-1267
(573) 332-0416

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
3056-7335
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1184774275
MO
Enumeration date
04/28/2016
Last updated
01/24/2024
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