NPIMap

Organization Active NPI

Gibson Center for Behavioral Change

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cape Girardeau, MO
National Provider Identifier
1679928501
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
3056-7335 Issued in MO
Legal business name
GIBSON CENTER FOR BEHAVIORAL CHANGE
Practice address
340 S Broadview St
Cape Girardeau, MO 63703-5703
Phone
(573) 332-0416
NPI assigned
Apr 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Authorized official

Name
Ryan Essex
Title
Chief Operating Officer
Phone
(573) 803-4145

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 3056-7335 MO Primary

Addresses

Primary practice location

340 S Broadview St
Cape Girardeau, MO 63703-5703

Mailing address

PO Box 1267
Cape Girardeau, MO 63702-1267
Phone (573) 332-0416

Other identifiers 1

IdentifierTypeStateIssuer
1184774275MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Gibson Center for Behavioral Change3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1679928501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1267",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637021267",
            "telephone_number": "573-332-0416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 S BROADVIEW ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637035703",
            "telephone_number": "573-332-0416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON CENTER FOR BEHAVIORAL CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-28",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A",
        "authorized_official_last_name": "ESSEX",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "573-803-4145"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MO",
            "license": "3056-7335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184774275",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.