Provider Demographics
NPI:1134671688
Name:GILTNER, ROBERT JR (MFTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GILTNER
Suffix:JR
Gender:M
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 RIVER SHORE DR APT 313
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2783
Mailing Address - Country:US
Mailing Address - Phone:502-640-5139
Mailing Address - Fax:
Practice Address - Street 1:4229 BARDSTOWN RD # 311
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-499-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168328106H00000X
KY175424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist