Healthcare Provider Details

I. General information

NPI: 1578611992
Provider Name (Legal Business Name): GREGORY FREDRICK MEBS LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4339 WINSTON AVE LATONIA CENTRE
COVINGTON KY
41015-1739
US

IV. Provider business mailing address

4339 WINSTON AVE LATONIA CENTRE
COVINGTON KY
41015-1739
US

V. Phone/Fax

Practice location:
  • Phone: 859-760-3025
  • Fax: 859-261-5487
Mailing address:
  • Phone: 859-760-3025
  • Fax: 859-261-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberKY-0225
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1097
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: