Healthcare Provider Details

I. General information

NPI: 1326479957
Provider Name (Legal Business Name): MARK ANTHONY GELIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2013
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 ASBURY DR SUITE E6
MANDEVILLE LA
70471-4101
US

IV. Provider business mailing address

815 BOCAGE LN
MANDEVILLE LA
70471-1521
US

V. Phone/Fax

Practice location:
  • Phone: 985-710-0587
  • Fax:
Mailing address:
  • Phone: 985-710-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: