Healthcare Provider Details

I. General information

NPI: 1770734857
Provider Name (Legal Business Name): MARIEL MITCHELL OTT GEBHARDT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 MACK BLVD
FAIRBANKS AK
99709-4004
US

IV. Provider business mailing address

PO BOX 80355
FAIRBANKS AK
99708-0355
US

V. Phone/Fax

Practice location:
  • Phone: 907-251-7664
  • Fax:
Mailing address:
  • Phone: 907-251-7664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: