Healthcare Provider Details

I. General information

NPI: 1699119115
Provider Name (Legal Business Name): GREGORY RUSSELL GATES MA, LMHC, CDP, MHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33309 1ST WAY S SUITE 203
FEDERAL WAY WA
98003-6260
US

IV. Provider business mailing address

33309 1ST WAY S SUITE 203
FEDERAL WAY WA
98003-6260
US

V. Phone/Fax

Practice location:
  • Phone: 253-952-2556
  • Fax: 253-952-6356
Mailing address:
  • Phone: 253-952-2556
  • Fax: 253-952-6356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 60039687
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60074511
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: