Healthcare Provider Details

I. General information

NPI: 1528103496
Provider Name (Legal Business Name): MICHELLE PEARL GAMBLE M. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

IV. Provider business mailing address

8903 KEY PENINSULA HWY N
LAKEBAY WA
98349-9326
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-3644
  • Fax: 253-884-2632
Mailing address:
  • Phone: 253-884-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60544428
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: