Healthcare Provider Details

I. General information

NPI: 1396893509
Provider Name (Legal Business Name): CORINNE GELFAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PROVIDENCE MINE ROAD SUITE #215
NEVADA CITY CA
95959
US

IV. Provider business mailing address

13105 ALDERPOINT
GRASS VALLEY CA
95945
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-7373
  • Fax:
Mailing address:
  • Phone: 530-265-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC30364
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC30364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: