Provider Demographics
NPI:1023246501
Name:NORMAN GIBSON, LCSW
Entity type:Organization
Organization Name:NORMAN GIBSON, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-444-2072
Mailing Address - Street 1:4865 RIVERBEND RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2631
Mailing Address - Country:US
Mailing Address - Phone:303-444-2072
Mailing Address - Fax:303-444-2372
Practice Address - Street 1:4865 RIVERBEND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2631
Practice Address - Country:US
Practice Address - Phone:303-444-2072
Practice Address - Fax:303-444-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09850141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty