Healthcare Provider Details

I. General information

NPI: 1558732941
Provider Name (Legal Business Name): GLAIZA GATDULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33530 1ST WAY S
FEDERAL WAY WA
98003-7332
US

IV. Provider business mailing address

33530 1ST WAY S
FEDERAL WAY WA
98003-7332
US

V. Phone/Fax

Practice location:
  • Phone: 253-339-9657
  • Fax:
Mailing address:
  • Phone: 253-339-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60978336
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: