Provider Demographics
NPI:1205247087
Name:GEBHART, MICHELLE (LISW-S)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GEBHART
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N. BARRON ST. SUITE B
Mailing Address - Street 2:P.O. BOX 750
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-0750
Mailing Address - Country:US
Mailing Address - Phone:937-456-2805
Mailing Address - Fax:937-456-2805
Practice Address - Street 1:204 N BARRON ST STE B
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1765
Practice Address - Country:US
Practice Address - Phone:937-456-2805
Practice Address - Fax:937-456-2805
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10086-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160307Medicaid