Healthcare Provider Details

I. General information

NPI: 1477723898
Provider Name (Legal Business Name): ELLIOT M GELLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 NW 20TH AVE SUITE 302
PORTLAND OR
97209-1443
US

IV. Provider business mailing address

811 NW 20TH AVE SUITE 302
PORTLAND OR
97209-1443
US

V. Phone/Fax

Practice location:
  • Phone: 503-224-1433
  • Fax:
Mailing address:
  • Phone: 503-224-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0709
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: