Christine Gibbon, PHD, LP, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP4789 Issued in MN

Legal business name

CHRISTINE GIBBON, PHD, LP, LLC

Practice address

5101 Olson Memorial Hwy
Suite 4002
Golden Valley, MN 55422-5149

Phone

(763) 595-7294

Fax

(763) 595-7293

NPI assigned

Nov 11, 2015

Last updated

Nov 11, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christine Gibbon, PHD, LPNPI 1295950368

Title

Owner

Phone

(763) 595-7294

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christine A Gibbon, PHD LP LLC

  • Psychologist
  • Bloomington, MN
  • NPI 1295950368
  Authorized official Same address or phone
• Judith Blair Henderson, PH.D.

  • Health Service Psychologist
  • Golden Valley, MN
  • NPI 1831132778
  NPD (past)

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

{
    "created_epoch": "1447200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447200000000",
    "number": "1346613478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 OLSON MEMORIAL HWY",
            "address_2": "SUITE 4002",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554225149",
            "telephone_number": "763-595-7294",
            "fax_number": "763-595-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 OLSON MEMORIAL HWY",
            "address_2": "SUITE 4002",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554225149",
            "telephone_number": "763-595-7294",
            "fax_number": "763-595-7293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTINE GIBBON, PHD, LP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-11",
        "last_updated": "2015-11-11",
        "status": "A",
        "authorized_official_last_name": "GIBBON",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-595-7294",
        "authorized_official_credential": "PHD, LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.