Healthcare Provider Details

I. General information

NPI: 1346152634
Provider Name (Legal Business Name): KELVIN GATHERU WAMAITHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 MARY ELDER RD NE
OLYMPIA WA
98506-5050
US

IV. Provider business mailing address

6207 72ND AVENUE CT W APT 307
UNIVERSITY PLACE WA
98467-4752
US

V. Phone/Fax

Practice location:
  • Phone: 360-528-2590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCAAR.CG.70127264
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: