Provider Demographics
NPI:1760296503
Name:GITTELSON PSYCHOLOGY SERVICES
Entity type:Organization
Organization Name:GITTELSON PSYCHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:GITTELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-538-4112
Mailing Address - Street 1:4705 LAUREL CANYON BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3998
Mailing Address - Country:US
Mailing Address - Phone:818-538-4112
Mailing Address - Fax:
Practice Address - Street 1:4705 LAUREL CANYON BLVD STE 204
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3998
Practice Address - Country:US
Practice Address - Phone:818-538-4112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty