Provider Demographics
NPI:1063297141
Name:IBACH, LUKE (MA)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:
Last Name:IBACH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 E PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-3132
Mailing Address - Country:US
Mailing Address - Phone:240-529-6146
Mailing Address - Fax:
Practice Address - Street 1:8591 HOLLY MEADOWS RD
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-8604
Practice Address - Country:US
Practice Address - Phone:304-478-3339
Practice Address - Fax:304-478-3311
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist