Provider Demographics
NPI:1720853773
Name:GELLE, MARYAN ABSHIR
Entity Type:Individual
Prefix:
First Name:MARYAN
Middle Name:ABSHIR
Last Name:GELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 W 141ST ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2666
Mailing Address - Country:US
Mailing Address - Phone:206-769-8160
Mailing Address - Fax:
Practice Address - Street 1:3344 SHERMAN CT STE 106
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-5009
Practice Address - Country:US
Practice Address - Phone:206-376-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician