Provider Demographics
NPI:1164162632
Name:KEPFORD, LIBERTY ELLEN
Entity Type:Individual
Prefix:
First Name:LIBERTY
Middle Name:ELLEN
Last Name:KEPFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIBERTY
Other - Middle Name:ELLEN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:DEETH
Mailing Address - State:NV
Mailing Address - Zip Code:89823-0057
Mailing Address - Country:US
Mailing Address - Phone:775-340-8580
Mailing Address - Fax:
Practice Address - Street 1:1900 DENNIS FLAT RD
Practice Address - Street 2:
Practice Address - City:DEETH
Practice Address - State:NV
Practice Address - Zip Code:89823-8982
Practice Address - Country:US
Practice Address - Phone:775-340-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician