Active NPI
Amanda Gibson, LCSW
- Mental Health Counselor
- Sacramento, CA
National Provider Identifier
1790888998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 25790
- Practice address
- 2617 K St Ste 125
Sacramento, CA 95816-5133 - Phone
- (916) 425-3311
- NPI assigned
- Sep 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 20197 | CA | |
| Clinical Social Worker | 1041C0700X | LCS25790 | CA | |
| Mental Health Counselor | 101YM0800X | 25790 | CA | Primary |
Addresses
Primary practice location
2617 K St Ste 125
Sacramento, CA 95816-5133
Mailing address
2617 K St Ste 125
Sacramento, CA 95816-5133
Phone (916) 425-3311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790888998 | Medicaid | CA |
Other names 1
- Amanda Gibson-CHI
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20197 | CA | MD | Pediatric Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amanda Gibson, LCSW | Current | Accepting new patients |
Locations
2617 K St
Ste 125
Sacramento, CA 95816
Phone (916) 425-3311
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.
-
- Community/Behavioral Health Agency
- Sacramento, CA
- NPI 1639857683
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157500800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679270400000",
"number": "1790888998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2617 K ST STE 125",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958165133",
"telephone_number": "916-425-3311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2617 K ST STE 125",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958165133",
"telephone_number": "916-425-3311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "AMANDA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-06",
"last_updated": "2023-03-20",
"certification_date": "2023-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "20197",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS25790",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "25790",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1790888998",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "GIBSON-CHI",
"credential": "ASSOCIATE SOCIAL WOR",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.