Provider Demographics
NPI:1871300574
Name:LAURA GIBBS COUNSELING, PLLC
Entity type:Organization
Organization Name:LAURA GIBBS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:309-863-5129
Mailing Address - Street 1:505 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61489-9517
Mailing Address - Country:US
Mailing Address - Phone:309-337-5999
Mailing Address - Fax:
Practice Address - Street 1:4507 N STERLING AVE STE 208A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3817
Practice Address - Country:US
Practice Address - Phone:309-863-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty