Provider Demographics
NPI:1194464719
Name:GITELSON, HALLE (EDS)
Entity Type:Individual
Prefix:
First Name:HALLE
Middle Name:
Last Name:GITELSON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 28TH ST APT 434
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-5256
Mailing Address - Country:US
Mailing Address - Phone:847-373-6132
Mailing Address - Fax:
Practice Address - Street 1:1859 28TH ST APT 434
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-5256
Practice Address - Country:US
Practice Address - Phone:847-373-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO352246103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool