Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1003180340 |
---|---|
Provider Name | Connie Francis Gibson |
First Address | Tigard, OR 97223-9103 |
Second Address | Tigard, OR 97223-9103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2012 |
Last Update Date | 05/03/2012 |