Provider Demographics
NPI:1821245192
Name:GEBHART, ERIC C (BS, CSAC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:GEBHART
Suffix:
Gender:M
Credentials:BS, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 STATE ROAD 69
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-9328
Mailing Address - Country:US
Mailing Address - Phone:608-527-2426
Mailing Address - Fax:608-527-1939
Practice Address - Street 1:1307 STATE ROAD 69
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9328
Practice Address - Country:US
Practice Address - Phone:608-527-2426
Practice Address - Fax:608-527-1939
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15274-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)