Provider Demographics
NPI:1336331107
Name:GEBHARDT, JAMIE (LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 KINGS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1162
Mailing Address - Country:US
Mailing Address - Phone:314-202-5933
Mailing Address - Fax:
Practice Address - Street 1:140 CLIFF CAVE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3646
Practice Address - Country:US
Practice Address - Phone:314-202-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO183046OtherANTHEM BCBS
MO431344414OtherCORPHEALTH
MO732506OtherHEALTHLINK
MO497624908Medicaid