Healthcare Provider Details

I. General information

NPI: 1235998022
Provider Name (Legal Business Name): ALEXANDER ROBERT GEBUR LMHC-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WILLOWBROOK RD
QUEENSBURY NY
12804-5882
US

IV. Provider business mailing address

25 WILLOWBROOK RD
QUEENSBURY NY
12804-5882
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-7100
  • Fax:
Mailing address:
  • Phone: 518-926-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P127447-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: