Healthcare Provider Details

I. General information

NPI: 1306232350
Provider Name (Legal Business Name): LAURA GEBHARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 FORT CAMPBELL BLVD
HOPKINSVILLE KY
42240-4929
US

IV. Provider business mailing address

PO BOX 614
HOPKINSVILLE KY
42241-0614
US

V. Phone/Fax

Practice location:
  • Phone: 270-886-2205
  • Fax: 270-886-0392
Mailing address:
  • Phone: 270-886-2205
  • Fax: 270-886-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: