Healthcare Provider Details

I. General information

NPI: 1174883268
Provider Name (Legal Business Name): LISA JILL GERBER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N WRIGHT AVE
CLE ELUM WA
98922-1132
US

IV. Provider business mailing address

270 SCOTT DR
CLE ELUM WA
98922-9458
US

V. Phone/Fax

Practice location:
  • Phone: 206-715-0374
  • Fax:
Mailing address:
  • Phone: 206-764-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60442239
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: