Active NPI
Michael Wayne Gibson, M. ED.
- Professional Counselor
- Houston, TX
National Provider Identifier
1043543465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 7635
- Practice address
- 4625 North Fwy
Houston, TX 77022-2914 - Phone
- (713) 697-0776
- Fax
- (713) 697-2309
- NPI assigned
- Sep 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 7635 | TX | Primary |
Addresses
Primary practice location
4625 North Fwy
Houston, TX 77022-2914
Mailing address
5415 Brian Haven Dr
Houston, TX 77091-5503
Phone (713) 688-1811
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1634099 01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7635 | TX | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329868800000",
"number": "1043543465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5415 BRIAN HAVEN DR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770915503",
"telephone_number": "713-688-1811",
"fax_number": "713-688-1911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4625 NORTH FWY",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770222914",
"telephone_number": "713-697-0776",
"fax_number": "713-697-2309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "MICHAEL",
"middle_name": "WAYNE",
"name_prefix": "Prof.",
"credential": "M. ED.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-09-16",
"last_updated": "2012-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "7635",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1634099 01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.