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General NPI Number Information
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NPI Number | 1760296503
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Entity Type | Organization
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Legal Business Name | GITTELSON PSYCHOLOGY SERVICES
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 4705 LAUREL CANYON BLVD STE 204
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3998
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Country | US
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Telephone | 818-538-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 4705 LAUREL CANYON BLVD STE 204
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3998
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Country | US
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Telephone | 818-538-4112
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR / OWNER
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Name | DR. MYAH T GITTELSON
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Credential | PSY.D.
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Telephone | 818-538-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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