| Mr Gary Grant Gibson, LPC, NCC, LPCC, | |
|
1601 Golf Course Rd, Grand Rapids, MN 55744-8648 | |
| (540) 682-3498 | |
| Not Available |
| Full Name | Mr Gary Grant Gibson |
|---|---|
| Gender | Male |
| Speciality | Counselor - Mental Health |
| Location | 1601 Golf Course Rd, Grand Rapids, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255526174 | NPI | - | NPPES |
| 1255526174 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 0701003993 (Virginia) | Secondary |
| 101YM0800X | Counselor - Mental Health | 00016 (Minnesota) | Primary |
| Entity Name | Grand Itasca Clinic And Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669426631 PECOS PAC ID: 8123939550 Enrollment ID: O20031105000209 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Gary Grant Gibson, LPC, NCC, LPCC, 11071 W Wegener Rd, Hibbing, MN 55746-8215 Ph: (540) 682-3498 | Mr Gary Grant Gibson, LPC, NCC, LPCC, 1601 Golf Course Rd, Grand Rapids, MN 55744-8648 Ph: (540) 682-3498 |
Kayla Marie Meyer, MS, LPCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 215 Se 2nd Ave, Grand Rapids, MN 55744 Phone: 218-326-1274 Fax: 218-326-9787 | |
Alyson Lopez, MA, LPCC Counselor Medicare: Medicare Enrolled Practice Location: 215 Se 2nd Ave, Grand Rapids, MN 55744 Phone: 218-326-1274 Fax: 218-326-9787 | |
Colleen Mackay, LADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1215 Se 7th Ave, Grand Rapids, MN 55744 Phone: 218-313-1315 | |
Bruce Haag, LADC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1215 Se 7th Ave, Grand Rapids, MN 55744 Phone: 218-327-1105 | |
Kelsey Unger, LPCC Counselor Medicare: Medicare Enrolled Practice Location: 35382 Us Highway 2, Grand Rapids, MN 55744 Phone: 218-327-4886 Fax: 218-327-4848 | |
Christina Smith, CD Counselor Medicare: Not Enrolled in Medicare Practice Location: 2086 Ridgeway Dr, Grand Rapids, MN 55744 Phone: 218-327-9944 | |
Bret Decker, CAS, ADC-T Counselor Medicare: Not Enrolled in Medicare Practice Location: 516 S Pokegama Ave, Grand Rapids, MN 55744 Phone: 218-327-2001 Fax: 218-327-0456 |