Healthcare Provider Details

I. General information

NPI: 1831615822
Provider Name (Legal Business Name): PAUL GEBBEN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 2ND AVE S STE 140
EDMONDS WA
98020-8439
US

IV. Provider business mailing address

2707 169TH ST SE
BOTHELL WA
98012-6542
US

V. Phone/Fax

Practice location:
  • Phone: 616-214-0818
  • Fax:
Mailing address:
  • Phone: 616-214-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60757154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: