Gibson Center for Behavioral Change

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

30567335 Issued in MO

Legal business name

GIBSON CENTER FOR BEHAVIORAL CHANGE

Practice address

1112 Linden St
Cape Girardeau, MO 63703-7707

Phone

(573) 332-0416

Fax

(573) 334-0312

NPI assigned

Jan 11, 2007

Organization subpart

No

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

Authorized official

Name

Ryan Essex

Title

Chief Operating Officer

Phone

(573) 803-4145

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Gibson Center for Behavioral Change3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Gibson Center for Behavioral Change

  • Mental Health Counselor
  • Cape Girardeau, MO
  • NPI 1164719373
  NPD tax ID
• Gibson Center for Behavioral Change

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cape Girardeau, MO
  • NPI 1679928501
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melanie A Martin, LPC

  • Mental Health Counselor
  • Steelville, MO
  • NPI 1427263979
  NPD (past)

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1184774275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1267",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637021267",
            "telephone_number": "573-332-0416",
            "fax_number": "573-334-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 LINDEN ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637037707",
            "telephone_number": "573-332-0416",
            "fax_number": "573-334-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON CENTER FOR BEHAVIORAL CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-11",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "ESSEX",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "573-803-4145"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MO",
            "license": "30567335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "863112702",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSSBLUE SHIELD",
            "identifier": "105152",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donald L. Gentle, M. D.
• P A George, MD
• Adil Ghaffar, M.D.
• Thomas Matthew Gibbons, O.D.
• Gibson Center for Behavioral Change
• Gibson Center for Behavioral Change
• Kelsey D Gibson, RD, LD
• Robert J Gile, M.D.
• Jamie Gillespie
• Stephanie Gilmore, LPC

• Substance Abuse Rehabilitation Facility in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Substance Abuse Rehabilitation Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.