| Gibson Ventures, Llc | |
|
1218 W South Jordan Pkwy Ste A2 South Jordan UT 84095-5946 | |
| (385) 645-8889 | |
| Not Available |
| Full Name | Gibson Ventures, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1218 W South Jordan Pkwy Ste A2, South Jordan, Utah |
| Authorized Official Name and Position | Brad Gibson (OWNER/MANAGER) |
| Authorized Official Contact | 8017357555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gibson Ventures, Llc 15047 S Bugle Ridge Dr Herriman UT 84096-5722 Ph: (801) 735-7555 | Gibson Ventures, Llc 1218 W South Jordan Pkwy Ste A2 South Jordan UT 84095-5946 Ph: (385) 645-8889 |
| NPI Number | 1336958735 |
|---|---|
| Provider Enumeration Date | 01/01/2025 |
| Last Update Date | 01/01/2025 |
| Certification Date | 01/01/2025 |
| Medicare PECOS PAC ID | 6901335918 |
|---|---|
| Medicare Enrollment ID | O20250121001384 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336958735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Amy Gibson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417780214 PECOS PAC ID: 7719416726 Enrollment ID: I20250123002322 |
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