Provider Demographics
NPI:1427285642
Name:GELSEBACH, WANDA L (MA,LMFT)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:L
Last Name:GELSEBACH
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:MS
Other - First Name:WANDA
Other - Middle Name:L
Other - Last Name:BEIERLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,LMFT
Mailing Address - Street 1:4419 VAN NUYS BLVD.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-981-3043
Mailing Address - Fax:
Practice Address - Street 1:4419 VAN NUYS BLVD.
Practice Address - Street 2:SUITE 404
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-981-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33884106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist