Healthcare Provider Details

I. General information

NPI: 1578156741
Provider Name (Legal Business Name): GAIA WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4945 MISSION ROAD
BELLINGHAM WA
98226-9528
US

IV. Provider business mailing address

4945 MISSION RD
BELLINGHAM WA
98226-9528
US

V. Phone/Fax

Practice location:
  • Phone: 304-319-0581
  • Fax: 888-972-8992
Mailing address:
  • Phone: 360-209-3391
  • Fax: 888-972-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: RIVES WHITTLE THORNTON
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 360-209-3391