Organization
BEACON ST. PSYCHIATRY
Active
Other names
A Life Renewed
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD GIBSON MBA, MSN, APRN (CEO/OWNER)
(937) 280-5711
Entity
Organization
Contact information
Practice address
10552 SUCCESS LN STE L, CENTERVILLE, OH 45458-3664
(937) 280-5711
Mailing address
10552 SUCCESS LN STE L, CENTERVILLE, OH 45458-3664
(937) 280-5711
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/01/2023
Last updated
01/24/2024
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