Individual
CHARLOTTE GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
EAST HIGHWAY 262, MONTEZUMA CREEK, UT 84534
(435) 651-3291
(435) 651-3376
Mailing address
PO BOX 130, MONTEZUMA CREEK, UT 84534
(435) 651-3291
(435) 651-3376
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
138698-3501
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138698-3501
STATE LICENSE
UT
Enumeration date
01/12/2010
Last updated
01/12/2010
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