Active NPI
Alexis Victoria Gibson, MA, LMFT
- Marriage & Family Therapist
- Los Osos, CA
National Provider Identifier
1336765908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 139818
- Practice address
- 2280 Sunset Dr Ste Ee
Los Osos, CA 93402-4026 - Phone
- (805) 242-1163
- NPI assigned
- Jun 19, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 121752 | CA | |
| Marriage & Family Therapist | 106H00000X | PMFT-295 | WY | |
| Marriage & Family Therapist | 106H00000X | 139818 | CA | Primary |
Addresses
Primary practice location
2280 Sunset Dr Ste Ee
Los Osos, CA 93402-4026
Mailing address
2101 Buckskin Dr
Los Osos, CA 93402-3001
Phone (805) 242-1163
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121752 | CA | MD | Mental Health Counselor |
| 139818 | CA | MD | Marriage & Family Therapist |
| PMFT-295 | WY | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Red Top Meadows | Mental Health | Past | Accepting new patients |
| Teton Youth and Family Services | Past | 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 and National Provider Directory roles.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Wilson, WY
- NPI 1144414780
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708041600000",
"number": "1336765908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 BUCKSKIN DR",
"city": "LOS OSOS",
"state": "CA",
"postal_code": "934023001",
"telephone_number": "805-242-1163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2280 SUNSET DR STE EE",
"city": "LOS OSOS",
"state": "CA",
"postal_code": "934024026",
"telephone_number": "805-242-1163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "ALEXIS",
"middle_name": "VICTORIA",
"credential": "MA, LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-19",
"last_updated": "2024-02-16",
"certification_date": "2024-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "121752",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "WY",
"license": "PMFT-295",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "139818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Osos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.