Healthcare Provider Details

I. General information

NPI: 1124816558
Provider Name (Legal Business Name): LG PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 WOODLAND SQUARE LOOP SE STE B6
LACEY WA
98503-1000
US

IV. Provider business mailing address

6642 STONE ST SE
LACEY WA
98513-4961
US

V. Phone/Fax

Practice location:
  • Phone: 360-585-4050
  • Fax: 360-282-1013
Mailing address:
  • Phone: 360-701-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN ROCHELE GAYLE
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 360-701-7281