MEDICARE: MAEVON ELLIOT GUMBLE MMT, MT-BC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist	12781
2	101YM0800X	Mental Health Counselor	PCO16736	PA

General Provider Information

NPI Number	:	1033727128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEVON ELLIOT GUMBLE MMT, MT-BC, LPC

Provider Business Mailing Address
First Line	:	2045 S PLEASANT VALLEY RD # 1075
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-7001
Country	:	US
Telephone Number	:	412-223-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 S PLEASANT VALLEY RD # 1075
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-7001
Country	:	US
Telephone Number	:	412-223-7067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	03/18/2026

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