Individual
AUDREY GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17685 JUNIPER PATH STE 303, LAKEVILLE, MN 55044-9821
(952) 214-8959
Mailing address
18941 EXCALIBUR TRL, FARMINGTON, MN 55024-7058
(651) 707-5080
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
23282
MN
Other
Enumeration date
02/25/2022
Last updated
02/25/2022
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