Healthcare Provider Details

I. General information

NPI: 1265563878
Provider Name (Legal Business Name): JESSICA GELSON MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 7TH ST SUITE 206
SANTA MONICA CA
90401-2629
US

IV. Provider business mailing address

1460 7TH ST SUITE 206
SANTA MONICA CA
90401-2629
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-8982
  • Fax:
Mailing address:
  • Phone: 310-820-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 43401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: