Healthcare Provider Details

I. General information

NPI: 1114742004
Provider Name (Legal Business Name): JORDAN CRAIG GABEL B.S. PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORDAN CRAIG GABEL CADC (TRAINEE)

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W BROADWAY ST
CAMPBELLSVILLE KY
42718-2701
US

IV. Provider business mailing address

214 E WALNUT ST
CAMPBELLSVILLE KY
42718-1232
US

V. Phone/Fax

Practice location:
  • Phone: 745-093-4866
  • Fax:
Mailing address:
  • Phone: 270-283-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: