Provider Demographics
NPI:1275860173
Name:GEPHART, LOUISE M (LCSW)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:M
Last Name:GEPHART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GARDINER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357-1336
Mailing Address - Country:US
Mailing Address - Phone:207-737-4359
Mailing Address - Fax:207-737-4412
Practice Address - Street 1:24 GARDINER ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357-1336
Practice Address - Country:US
Practice Address - Phone:207-737-4359
Practice Address - Fax:207-737-4412
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC78101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor