Provider Demographics
NPI:1467473934
Name:GABEHART, JUDY DIANE (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:DIANE
Last Name:GABEHART
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:DIANE
Other - Last Name:GABEHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1215 SW G ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2544
Mailing Address - Country:US
Mailing Address - Phone:541-476-2373
Mailing Address - Fax:
Practice Address - Street 1:1911 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1630
Practice Address - Country:US
Practice Address - Phone:541-476-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157194101YP2500X
ORC7322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494879539Medicaid
MO743098138OtherTAX IDENTIFICATION NUMBER