Healthcare Provider Details

I. General information

NPI: 1598422339
Provider Name (Legal Business Name): VICTORIA GELBACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA SIMONS

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 E BROADWAY STE 340
COLUMBIA MO
65201-7167
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2021043397
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023050468
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: