Provider Demographics
NPI:1609884550
Name:RICHARD GELB PHD ABPN PC
Entity Type:Organization
Organization Name:RICHARD GELB PHD ABPN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OF RICHARD GELB PHD ABPN PC
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GELB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LCSW LCAS RN
Authorized Official - Phone:734-324-8930
Mailing Address - Street 1:20500 EUREKA ROAD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5370
Mailing Address - Country:US
Mailing Address - Phone:734-324-8930
Mailing Address - Fax:734-324-8931
Practice Address - Street 1:20500 EUREKA ROAD
Practice Address - Street 2:SUITE 315
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5370
Practice Address - Country:US
Practice Address - Phone:734-324-8930
Practice Address - Fax:734-324-8931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005856103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI038909OtherBLUE CARE NETWORK OF MI
2022608OtherCIGNA BEH
MIOH230440OtherBLUE CROSS BLUE SHIELD MI
038909OtherVALUE OPTIONS
=========OtherTRICARE
=========OtherAPS
038909OtherVALUE OPTIONS
MI038909OtherBLUE CARE NETWORK OF MI