Healthcare Provider Details

I. General information

NPI: 1770684607
Provider Name (Legal Business Name): DEBBIE J GEPHARDT RN, MS, MFT, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6859 W CHARLESTON BLVD
LAS VEGAS NV
89117-1600
US

IV. Provider business mailing address

2451 GRANADA BLUFF CT
LAS VEGAS NV
89135-1341
US

V. Phone/Fax

Practice location:
  • Phone: 702-496-3597
  • Fax:
Mailing address:
  • Phone: 702-240-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 0987
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: