Provider Demographics
NPI:1114742004
Name:GABEL, JORDAN CRAIG (BS PSYCHOLOGY)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:CRAIG
Last Name:GABEL
Suffix:
Gender:M
Credentials:BS PSYCHOLOGY
Other - Prefix:MR
Other - First Name:JORDAN
Other - Middle Name:CRAIG
Other - Last Name:GABEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC (TRAINEE)
Mailing Address - Street 1:214 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1232
Mailing Address - Country:US
Mailing Address - Phone:270-283-0309
Mailing Address - Fax:
Practice Address - Street 1:830 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2701
Practice Address - Country:US
Practice Address - Phone:745-093-4866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103T00000X, 103TA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)