Healthcare Provider Details

I. General information

NPI: 1467079525
Provider Name (Legal Business Name): GWENDOLYN SPENCER BARNHART PHD, PSYD, EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 204TH AVENUE CT SW
LAKEBAY WA
98349-9473
US

IV. Provider business mailing address

609 204TH AVENUE CT SW
LAKEBAY WA
98349-9473
US

V. Phone/Fax

Practice location:
  • Phone: 253-331-1530
  • Fax: 855-878-3079
Mailing address:
  • Phone: 253-331-1530
  • Fax: 855-878-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61254557
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2269
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61265998
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number235193
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4050
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberCP70010956
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: