Provider Demographics
NPI:1205126653
Name:GIBSON, LEA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LEA
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N 400 W
Mailing Address - Street 2:
Mailing Address - City:EPHRAIM
Mailing Address - State:UT
Mailing Address - Zip Code:84627-5549
Mailing Address - Country:US
Mailing Address - Phone:435-283-8400
Mailing Address - Fax:435-462-8407
Practice Address - Street 1:390 W 100 N
Practice Address - Street 2:
Practice Address - City:EPHRAIM
Practice Address - State:UT
Practice Address - Zip Code:84627-2131
Practice Address - Country:US
Practice Address - Phone:435-283-4065
Practice Address - Fax:435-462-8407
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70050273503101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor