Elisabeth Breiman Gibson, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

124861 Issued in IA

Practice address

2201 SE Loop 820
Fort Worth, TX 76119-5863

Phone

(626) 318-3424

NPI assigned

Jan 18, 2019

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1447724828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 WILDPLUM DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760152030",
            "telephone_number": "626-318-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 SE LOOP 820",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761195863",
            "telephone_number": "626-318-3424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2805 Wildplum Dr",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "TX",
            "postal_code": "760152030",
            "country_code": "US",
            "telephone_number": "626-318-3424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "ELISABETH",
        "middle_name": "BREIMAN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-18",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "124861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony E Gibson Sr.
• Blake Nicole Gibson, M.S., CCC-SLP
• Bridgett Gibson
• Carli Charisse Gibson, LPC
• Diana Kristine Gibson, LPC
• Keenan Gibson, DO
• Lakisha Gibson, CHW
• Larisa Janae Gibson
• Morgan Gibson
• Presley Gibson

• Clinical Psychologist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.