Provider Demographics
NPI:1376841908
Name:GEBERT, KATHLEEN A
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:GEBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:330 KAY LARKIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-2307
Mailing Address - Country:US
Mailing Address - Phone:386-329-3780
Mailing Address - Fax:386-385-1269
Practice Address - Street 1:330 KAY LARKIN DRIVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-2307
Practice Address - Country:US
Practice Address - Phone:386-329-3780
Practice Address - Fax:386-385-1269
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor