Healthcare Provider Details

I. General information

NPI: 1528948833
Provider Name (Legal Business Name): SAMUEL HAYES GELBER MFTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 BOARDWALK DR STE 120
FORT COLLINS CO
80525-3798
US

IV. Provider business mailing address

5624 TAYLOR LN
FORT COLLINS CO
80528-9100
US

V. Phone/Fax

Practice location:
  • Phone: 970-387-6883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0014623
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: