Active NPI
Mary L Gibson, MS
- Counselor
- Green Bay, WI
National Provider Identifier
1205044112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1196-125
- Practice address
- 301 E Saint Joseph St
Green Bay, WI 54301-2241 - Phone
- (920) 430-3630
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 1196-125 | WI | Primary |
Addresses
Primary practice location
301 E Saint Joseph St
Green Bay, WI 54301-2241
Mailing address
301 E Saint Joseph St
Green Bay, WI 54301-2241
Phone (920) 430-3630
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1196-125 | Other | WI | LICENSE NUMBER |
| 43561600 | Medicaid | WI |
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 Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1196-125 | WI | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1205044112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 E SAINT JOSEPH ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543012241",
"telephone_number": "920-430-3630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E SAINT JOSEPH ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543012241",
"telephone_number": "920-430-3630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "MARY",
"middle_name": "L",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WI",
"license": "1196-125",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "1196-125",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43561600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
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.