Provider Demographics
NPI:1487619342
Name:MITCHELL L GELBER EDD PC
Entity type:Organization
Organization Name:MITCHELL L GELBER EDD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GELBER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:928-777-0919
Mailing Address - Street 1:804 AINSWORTH DRIVE
Mailing Address - Street 2:#105
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-777-0919
Mailing Address - Fax:928-777-8897
Practice Address - Street 1:804 AINSWORTH DRIVE
Practice Address - Street 2:#105
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-777-0919
Practice Address - Fax:928-777-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1621103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN FEDERAL
ZEDD1621Medicare ID - Type Unspecified