Healthcare Provider Details

I. General information

NPI: 1669393583
Provider Name (Legal Business Name): SUSAN GABRIELLE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 RICHARDS RD STE 202
BELLEVUE WA
98005-4200
US

IV. Provider business mailing address

25025 SE KLAHANIE BLVD APT G204
SAMMAMISH WA
98029-7791
US

V. Phone/Fax

Practice location:
  • Phone: 425-830-6836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61668751
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: