Provider Demographics
NPI:1740346345
Name:GABHART, GLENDA FRANCIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:FRANCIS
Last Name:GABHART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 ASHLEY CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3337
Mailing Address - Country:US
Mailing Address - Phone:270-782-6121
Mailing Address - Fax:270-843-1888
Practice Address - Street 1:1725 ASHLEY CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3337
Practice Address - Country:US
Practice Address - Phone:270-782-6121
Practice Address - Fax:270-843-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-11971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-1197OtherKY BOARD OF SOCIAL WORK
KY8200081100Medicaid
KY0759103Medicare PIN