Healthcare Provider Details

I. General information

NPI: 1790427839
Provider Name (Legal Business Name): ASHLEY ANNE GEBALLE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 ALICE ST APT 413
OAKLAND CA
94612-4375
US

IV. Provider business mailing address

1815 ALICE ST APT 413
OAKLAND CA
94612-4375
US

V. Phone/Fax

Practice location:
  • Phone: 920-264-5464
  • Fax:
Mailing address:
  • Phone: 920-264-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: