Provider Demographics
NPI:1700060316
Name:GELBER, MITCHELL L (EDD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:GELBER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 AINSWORTH DR
Mailing Address - Street 2:SUITE #105
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1624
Mailing Address - Country:US
Mailing Address - Phone:928-777-0919
Mailing Address - Fax:
Practice Address - Street 1:804 AINSWORTH DR
Practice Address - Street 2:SUITE #105
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1624
Practice Address - Country:US
Practice Address - Phone:928-777-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1621103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104513Medicaid
R09272Medicare UPIN