Provider Demographics
NPI:1063847119
Name:GEBHARDT, ANN MARIE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4710
Mailing Address - Country:US
Mailing Address - Phone:330-372-2200
Mailing Address - Fax:
Practice Address - Street 1:1705 WOODLAND ST NE STE A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5348
Practice Address - Country:US
Practice Address - Phone:330-469-6777
Practice Address - Fax:330-469-6779
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1200170101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12402Medicaid