Healthcare Provider Details

I. General information

NPI: 1386224392
Provider Name (Legal Business Name): MARIAH RENEE GIBBS N.C.C., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 01/13/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SW 27TH ST
RENTON WA
98057-2603
US

IV. Provider business mailing address

1200 SW 27TH ST
RENTON WA
98057-2603
US

V. Phone/Fax

Practice location:
  • Phone: 800-287-2680
  • Fax:
Mailing address:
  • Phone: 800-287-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013168
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61251783
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: