Healthcare Provider Details

I. General information

NPI: 1851568406
Provider Name (Legal Business Name): ERIN KATHLEEN GIST MA, LMHC, CMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12220 113TH AVE NE STE 210
KIRKLAND WA
98034-6950
US

IV. Provider business mailing address

12220 113TH AVE NE STE 210
KIRKLAND WA
98034-6950
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-5641
  • Fax:
Mailing address:
  • Phone: 425-502-5641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH60214683
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60214683
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60214683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: