Healthcare Provider Details

I. General information

NPI: 1871760850
Provider Name (Legal Business Name): BETTY GABHART LSW, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 7TH ST
JEFFERSONVILLE IN
47130-4031
US

IV. Provider business mailing address

525 E 7TH ST
JEFFERSONVILLE IN
47130-4031
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-4449
  • Fax:
Mailing address:
  • Phone: 812-288-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3300547A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000733A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: