Provider Demographics
NPI:1861115800
Name:ILIANA GELLES, LMFT A MARRIAGE AND FAMILY THERAPY PROFESSIONAL COORPOR
Entity type:Organization
Organization Name:ILIANA GELLES, LMFT A MARRIAGE AND FAMILY THERAPY PROFESSIONAL COORPOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO MAIN PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-430-4277
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:BUELLTON
Mailing Address - State:CA
Mailing Address - Zip Code:93427-1206
Mailing Address - Country:US
Mailing Address - Phone:805-350-8862
Mailing Address - Fax:
Practice Address - Street 1:1693 MISSION DR STE 201B
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2635
Practice Address - Country:US
Practice Address - Phone:805-430-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty