Healthcare Provider Details

I. General information

NPI: 1720366115
Provider Name (Legal Business Name): MEBS AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4339 WINSTON AVE
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: 859-835-2573
  • Fax: 859-727-6327
Mailing address:
  • Phone: 859-835-2573
  • Fax: 859-727-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0225
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1097
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1097
License Number StateKY

VIII. Authorized Official

Name: MR. GREGORY F. MEBS
Title or Position: CEO
Credential: LCSW, LCADC
Phone: 859-760-3025