Provider Demographics
NPI:1912028127
Name:GELB, RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GELB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 EUREKA RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6332
Mailing Address - Country:US
Mailing Address - Phone:734-324-8930
Mailing Address - Fax:734-324-8931
Practice Address - Street 1:20500 EUREKA RD
Practice Address - Street 2:SUITE 315
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6332
Practice Address - Country:US
Practice Address - Phone:734-324-8930
Practice Address - Fax:734-324-8931
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005856103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI235392OtherMHN
MI038909OtherVALUE OPTIONS
MI2022608OtherCIGNA
MIOH230440OtherBLUE CROSS BLUE SHIELD
MI235392OtherMHN
MISO9332Medicare UPIN