Provider Demographics
NPI:1932675873
Name:EBELING-RODRIGUEZ, GABRIELLE (MED, LPCC, ATR)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:EBELING-RODRIGUEZ
Suffix:
Gender:F
Credentials:MED, LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S FLOYD ST # W204
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2805
Mailing Address - Country:US
Mailing Address - Phone:404-769-1202
Mailing Address - Fax:
Practice Address - Street 1:2100 S FLOYD ST # W204
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2805
Practice Address - Country:US
Practice Address - Phone:404-769-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163684221700000X
KY240549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty