Gibson Behavioral Health LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GIBSON BEHAVIORAL HEALTH LLC

Practice address

4425 W Olive Ave Ste 203
Glendale, AZ 85302-3853

Phone

(312) 599-8267

NPI assigned

Jun 12, 2023

Organization subpart

No

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

Authorized official

Name

Lissa Sebatu

Title

Ceo

Phone

(312) 599-8267

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1104500909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 W OLIVE AVE STE 203",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853023853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 W OLIVE AVE STE 203",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853023853",
            "telephone_number": "312-599-8267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "SEBATU",
        "authorized_official_first_name": "LISSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "312-599-8267"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nilofar Ghulam Hazrat, PHARM.D
• Kathleen Giacini, MAED
• Derrek Giansiracusa
• Giardina Sportsmedicine Consultants, Inc.
• Casey Robert Giblin
• Heather Gibson, DPT
• Jackson Thomas Gibson
• Jasmine Gibson
• Mischelle Latoya Giffith Downer
• Alaina Gignac, DPT

• Mental Health Clinic/Center (Including Community Mental Health Center) in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.