Healthcare Provider Details

I. General information

NPI: 1427285642
Provider Name (Legal Business Name): WANDA L GELSEBACH MA,LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WANDA L BEIERLE MA,LMFT

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 VAN NUYS BLVD. SUITE 404
SHERMAN OAKS CA
91403
US

IV. Provider business mailing address

4419 VAN NUYS BLVD. SUITE 404
SHERMAN OAKS CA
91403
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-3043
  • Fax:
Mailing address:
  • Phone: 818-981-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 33884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: