Active NPI
Kenneth Marvin Gibson, PC
- Counselor
- Cuyahoga Falls, OH
National Provider Identifier
1154520518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- C4872
- Practice address
- 2231 Broad Blvd
Cuyahoga Falls, OH 44223-1411 - Phone
- (800) 363-9886
- Fax
- (330) 922-9977
- NPI assigned
- Jul 16, 2007
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | C4872 | OH | Primary |
Addresses
Primary practice location
2231 Broad Blvd
Cuyahoga Falls, OH 44223-1411
Mailing address
2231 Broad Blvd
Cuyahoga Falls, OH 44223-1411
Phone (800) 363-9886
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C4872 | OH | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184544000000",
"number": "1154520518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2231 BROAD BLVD",
"city": "CUYAHOGA FALLS",
"state": "OH",
"postal_code": "442231411",
"telephone_number": "800-363-9886",
"fax_number": "330-922-9977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2231 BROAD BLVD",
"city": "CUYAHOGA FALLS",
"state": "OH",
"postal_code": "442231411",
"telephone_number": "800-363-9886",
"fax_number": "330-922-9977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "KENNETH",
"middle_name": "MARVIN",
"credential": "PC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-16",
"last_updated": "2007-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OH",
"license": "C4872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cuyahoga Falls, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.