Provider Demographics
NPI:1629480348
Name:GEBHARDT, KAREN (PSYS,NCSP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:PSYS,NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-4432
Mailing Address - Country:US
Mailing Address - Phone:440-520-5100
Mailing Address - Fax:
Practice Address - Street 1:11005 PARKHURST DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3601
Practice Address - Country:US
Practice Address - Phone:216-476-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1200517103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH235Z00000XMedicaid