Provider Demographics
NPI:1770684607
Name:GEPHARDT, DEBBIE J (RN, MS, MFT, LADC)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:J
Last Name:GEPHARDT
Suffix:
Gender:F
Credentials:RN, MS, MFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 GRANADA BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1341
Mailing Address - Country:US
Mailing Address - Phone:702-240-1840
Mailing Address - Fax:
Practice Address - Street 1:6859 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1600
Practice Address - Country:US
Practice Address - Phone:702-496-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLMFT 0987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist