Healthcare Provider Details

I. General information

NPI: 1093432544
Provider Name (Legal Business Name): ALYSSA GELBURD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASA GELBURD

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W HOLLY LN
EUREKA CA
95503-7930
US

IV. Provider business mailing address

PO BOX 163
CUTTEN CA
95534-0163
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-0977
  • Fax:
Mailing address:
  • Phone: 505-585-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0661
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: