Healthcare Provider Details

I. General information

NPI: 1639229644
Provider Name (Legal Business Name): CHARLYNE M GELT PRICE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLYNE M GELT PRICE

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 VENTURA BLVD SUITE 1129
ENCINO CA
91436
US

IV. Provider business mailing address

16055 VENTURA BLVD SUITE 1129
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-4123
  • Fax: 818-906-1344
Mailing address:
  • Phone: 818-501-4123
  • Fax: 818-906-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number29972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: