Vanessa Gibson, MS, LLP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6361003791 Issued in MI

Practice address

835 Mason St Ste B220
Dearborn, MI 48124-2262

Phone

(313) 561-9064

Fax

(313) 563-4480

NPI assigned

Jan 3, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Michigan Modern Psychology Group,PLLC

  • Clinical Psychologist
  • Dearborn, MI
  • NPI 1447701255
  Medicare reassignment NPD

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1770640252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 MASON ST STE B220",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242262",
            "telephone_number": "313-561-9064",
            "fax_number": "313-563-4480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 MASON ST STE B220",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481242262",
            "telephone_number": "313-561-9064",
            "fax_number": "313-563-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "VANESSA",
        "credential": "MS, LLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6361003791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6361003791",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6301011057",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "V0011057",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea Gibson
• Deanna Gibson
• Eric Gibson
• Jada Gibson
• Megan Lynn Gibson
• Gwyneth Gielow
• Victoria R Gilbert
• Monay Gill
• Albino Felix Gimenez, M.D.
• Kelly J Gingras, PA-C

• Psychologist in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.