Provider Demographics
NPI:1033727128
Name:GUMBLE, MAEVON (MMT, MT-BC, LPC)
Entity Type:Individual
Prefix:
First Name:MAEVON
Middle Name:
Last Name:GUMBLE
Suffix:
Gender:F
Credentials:MMT, MT-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 PENN AVE # 315
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1626
Mailing Address - Country:US
Mailing Address - Phone:412-223-7067
Mailing Address - Fax:
Practice Address - Street 1:5150 PENN AVE # 315
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1626
Practice Address - Country:US
Practice Address - Phone:412-223-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12781225A00000X
PAPCO16736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist