| Christine Gibbon, Phd, Lp, Llc | |
|
5101 Olson Memorial Hwy Suite 4002 Golden Valley MN 55422-5149 | |
| (763) 595-7294 | |
| (763) 595-7293 |
| Full Name | Christine Gibbon, Phd, Lp, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 5101 Olson Memorial Hwy, Golden Valley, Minnesota |
| Authorized Official Name and Position | Christine Gibbon (OWNER) |
| Authorized Official Contact | 7635957294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Christine Gibbon, Phd, Lp, Llc 5101 Olson Memorial Hwy Suite 4002 Golden Valley MN 55422-5149 Ph: (763) 595-7294 | Christine Gibbon, Phd, Lp, Llc 5101 Olson Memorial Hwy Suite 4002 Golden Valley MN 55422-5149 Ph: (763) 595-7294 |
| NPI Number | 1346613478 |
|---|---|
| Provider Enumeration Date | 11/11/2015 |
| Last Update Date | 11/11/2015 |
| Medicare PECOS PAC ID | 2860794294 |
|---|---|
| Medicare Enrollment ID | O20151231001239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346613478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP4789 (Minnesota) | Primary |
| Provider Name | Christine A Gibbon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295950368 PECOS PAC ID: 7618159203 Enrollment ID: I20110302000810 |
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