Healthcare Provider Details

I. General information

NPI: 1033727128
Provider Name (Legal Business Name): MAEVON ELLIOT GUMBLE MMT, MT-BC, LPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 S PLEASANT VALLEY RD # 1075
WINCHESTER VA
22601-7001
US

IV. Provider business mailing address

2045 S PLEASANT VALLEY RD # 1075
WINCHESTER VA
22601-7001
US

V. Phone/Fax

Practice location:
  • Phone: 412-223-7067
  • Fax:
Mailing address:
  • Phone: 412-223-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12781
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPCO16736
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: