Individual provider Active NPI

Tricia K. Gibson, M.A., LMFT

  • Marriage & Family Therapist
  • Fridley, MN
National Provider Identifier
1073625182
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LMFT 1081 Issued in MN
Practice address
7260 University Ave NE
Suite 235
Fridley, MN 55432-3126
Phone
(763) 572-2605
Fax
(763) 572-2606
NPI assigned
Aug 31, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LMFT 1081 MN Primary

Addresses

Primary practice location

7260 University Ave NE
Suite 235
Fridley, MN 55432-3126

Mailing address

1849 73Rd St
Centerville, MN 55038-9626
Phone (651) 653-8036

Other identifiers 1

IdentifierTypeStateIssuer
81G95GIOtherMNBCBS OF MN

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 Arts

State licenses

LicenseStateTypeSpecialty
LMFT 1081MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Affiliated Counseling Center Marriage & Family Therapist PastSince Oct 19, 2009 Accepting new patients
Aria Counseling Assessment and Mediation Centers PLLC PastSince Jan 1, 2014 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1073625182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1849 73RD ST",
            "city": "CENTERVILLE",
            "state": "MN",
            "postal_code": "550389626",
            "telephone_number": "651-653-8036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7260 UNIVERSITY AVE NE",
            "address_2": "SUITE 235",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323126",
            "telephone_number": "763-572-2605",
            "fax_number": "763-572-2606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "TRICIA",
        "middle_name": "K.",
        "name_prefix": "Mrs.",
        "credential": "M.A., LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "LMFT 1081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "81G95GI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.