Healthcare Provider Details

I. General information

NPI: 1578005054
Provider Name (Legal Business Name): DIXIE GEBERT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CLUB DR
WESTERVILLE OH
43081-4909
US

IV. Provider business mailing address

900 CLUB DR
WESTERVILLE OH
43081-4909
US

V. Phone/Fax

Practice location:
  • Phone: 614-899-2838
  • Fax: 614-899-2872
Mailing address:
  • Phone: 614-899-2838
  • Fax: 614-899-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0700412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: