Provider Information for 1033288055
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Mr. PATRICK ROBERT GIBSON LPC, LMFT
Sex: Male
NPI: 1033288055
Last Updated: 2023-06-14
Certification Date: 2023-06-14
Certification Date: 2023-06-14
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1033288055 | ||||||||
| Enumeration Date | 2006-11-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1716 WATSON ST FORT WORTH, TX 76103-2044 United States Phone: 817-451-3380 | Fax:817-451-1331 | ||||||||
| Primary Practice Address | 1020 S CARRIER PKWY GRAND PRAIRIE, TX 75051-1527 United States Phone: 214-743-1200 | Fax:817-451-1331 | ||||||||
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