1386830180 NPI number — K REED GEHRING LCSW-C LLC

Table of content: (NPI 1386830180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386830180 NPI number — K REED GEHRING LCSW-C LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K REED GEHRING LCSW-C LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386830180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4832 BRIGHTLEAF CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237-4946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-588-8753
Provider Business Mailing Address Fax Number:
443-231-4331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
939 ELKRIDGE LANDING RD STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINTHICUM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21090-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-354-8903
Provider Business Practice Location Address Fax Number:
443-231-4331
Provider Enumeration Date:
09/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEHRING
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
REED
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
443-588-8753

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 06645 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 232181500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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