Healthcare Provider Details

I. General information

NPI: 1154733541
Provider Name (Legal Business Name): AUDE GELTZER M.A, L.M.H.C A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 08/27/2022
Certification Date: 08/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 80TH AVE SE
MERCER ISLAND WA
98040-4835
US

IV. Provider business mailing address

5803 80TH AVE SE
MERCER ISLAND WA
98040-4835
US

V. Phone/Fax

Practice location:
  • Phone: 206-612-1719
  • Fax:
Mailing address:
  • Phone: 206-612-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60430476
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60868909
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: