Earl Gibson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

016854074 Issued in CT

Practice address

26421 Pepperwood LN
San Juan Capistrano, CA 92675-1133

Phone

(860) 309-2092

NPI assigned

Dec 17, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1229472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229472000000",
    "number": "1982840112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26421 PEPPERWOOD LN",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26421 PEPPERWOOD LN",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751133",
            "telephone_number": "860-309-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "EARL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-17",
        "last_updated": "2008-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CT",
            "license": "016854074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; 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.