Active NPI
Kenneth Richard Gibson III, PH.D.
- Psychologist
- Northville, MI
National Provider Identifier
1457548067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301002367
- Practice address
- 18471 Haggerty Rd
Northville, MI 48168-8513 - Phone
- (248) 735-6713
- Fax
- (248) 349-6893
- NPI assigned
- Sep 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301002367 | MI | Primary |
Addresses
Primary practice location
18471 Haggerty Rd
Northville, MI 48168-8513
Mailing address
18471 Haggerty Rd
Northville, MI 48168-8513
Phone (248) 735-6713
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301002367 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Michigan | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatric Hospital
- Westland, MI
- NPI 1053480905
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190851200000",
"number": "1457548067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18471 HAGGERTY RD",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481688513",
"telephone_number": "248-735-6713",
"fax_number": "248-349-6893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18471 HAGGERTY RD",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481688513",
"telephone_number": "248-735-6713",
"fax_number": "248-349-6893"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "KENNETH",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-27",
"last_updated": "2007-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301002367",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.