1336184639 NPI number — DR. KAREN T GEHLE PH.D., BCBA-D

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336184639 NPI number — DR. KAREN T GEHLE PH.D., BCBA-D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEHLE
Provider First Name:
KAREN
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., BCBA-D
Provider Gender Code:
F

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:
1336184639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2138 N STATE HIGHWAY 19
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMORY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75440-4361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-474-4015
Provider Business Mailing Address Fax Number:
903-473-2007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
886 E LENNON DR
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
EMORY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75440-3246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-474-4015
Provider Business Practice Location Address Fax Number:
903-473-2007
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  22307 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1156077 04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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