Provider Demographics
NPI:1790153716
Name:IBERSHOFF, EMILY CONRAD (LPCC MT-BC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CONRAD
Last Name:IBERSHOFF
Suffix:
Gender:F
Credentials:LPCC MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 KIRBY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1542
Mailing Address - Country:US
Mailing Address - Phone:502-509-5380
Mailing Address - Fax:
Practice Address - Street 1:3518 KIRBY LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1542
Practice Address - Country:US
Practice Address - Phone:502-509-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPROCOUPCC00214788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health