Stacey L Gibson, DBH MBS MS LPC S

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4047 Issued in OK

Practice address

1312 N 1St Ave
Durant, OK 74701-2810

Phone

(580) 920-2069

Fax

(580) 920-1010

NPI assigned

Jul 8, 2007

Last updated

Oct 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Center for Psychological Development IncGroup PAC ID 5395929384, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Grayson Home Health, Inc.

  • Home Health Agency
  • Durant, OK
  • NPI 1801062518

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer

  CMS ownership

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Center for Psychological Development, Inc.

  • Mental Health Counselor
  • Durant, OK
  • NPI 1831409440
  Medicare reassignment Care Compare group NPD Authorized official
• Diversified Consulting, Inc.

  dba Center for Psychological Development

  • Community/Behavioral Health Agency
  • Durant, OK
  • NPI 1922297803
  Authorized official Same address or phone
• Diversified Consulting, Inc.

  dba Center for Psychological Development

  • Clinical Psychologist
  • Sherman, TX
  • NPI 1528186673
  NPD (past) Authorized official

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

{
    "created_epoch": "1183852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1346448669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 N 1ST AVE",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012810",
            "telephone_number": "580-920-2069",
            "fax_number": "580-920-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 N 1ST AVE",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012810",
            "telephone_number": "580-920-2069",
            "fax_number": "580-920-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "STACEY",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "DBH MBS MS LPC S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-08",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "59165",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "4047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gracie Giannini
• Jadyn Brooke Gibbs, PTA
• Danica Gibson
• Janice Rae Gibson
• Maurissa Renee Gibson
• Tammie Kim Gilbert
• Christian Giles
• Cynthia Diane Gill, LMT
• Nikki Gill
• Sierra Gillard

• Mental Health Counselor in Durant, OK
• Providers in Durant, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• 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.