Organization
MARCIA S. GIBSON, PSY.D AND ASSOCIATES, P. C..
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCIA SUSAN GIBSON PSY.D. (PRESIDENT)
(630) 759-4000
Entity
Organization
Contact information
Practice address
404 W BOUGHTON RD STE B, BOLINGBROOK, IL 60440-1898
(630) 759-4000
(630) 759-5220
Mailing address
404 W BOUGHTON RD STE B, BOLINGBROOK, IL 60440-1898
(630) 759-4000
(630) 759-5220
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
071007322
IL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
071007322
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346434883
NATIONAL PROVIDER IDENTIFICATION ENUMERATOR, TYPE 1
IL
Enumeration date
11/23/2009
Last updated
04/20/2016
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