Healthcare Provider Details

I. General information

NPI: 1528934106
Provider Name (Legal Business Name): DEBBIE MAYTE GELISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 HAINES
LIBERTY MO
64068-1006
US

IV. Provider business mailing address

120 SW GARDEN ST
GRAIN VALLEY MO
64029-9548
US

V. Phone/Fax

Practice location:
  • Phone: 816-265-1170
  • Fax:
Mailing address:
  • Phone: 816-265-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-480364
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: