Individual
ELIZABETH A GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
300 W MAIN ST STE 201, BOISE, ID 83702-7707
(208) 861-1844
Mailing address
910 N 22ND ST, BOISE, ID 83702-3219
(208) 861-1844
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-381
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010032814
REGENCE BLUE SHIELD
ID
05
—
002269500
—
ID
01
—
Q2495
BLUE CROSS
ID
01
—
X4195
BLUE CROSS
ID
Enumeration date
03/16/2007
Last updated
03/08/2024
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