Provider Demographics
NPI:1578611992
Name:MEBS, GREGORY FREDRICK (LCSW, CADC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:FREDRICK
Last Name:MEBS
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4339 WINSTON AVE
Mailing Address - Street 2:LATONIA CENTRE
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-1739
Mailing Address - Country:US
Mailing Address - Phone:859-760-3025
Mailing Address - Fax:859-261-5487
Practice Address - Street 1:4339 WINSTON AVE
Practice Address - Street 2:LATONIA CENTRE
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1739
Practice Address - Country:US
Practice Address - Phone:859-760-3025
Practice Address - Fax:859-261-5487
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0225101YA0400X
KY10971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12517483OtherCAQH
KY7100270040Medicaid