Healthcare Provider Details

I. General information

NPI: 1780956664
Provider Name (Legal Business Name): MONIKA GYDOS MA, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 15TH AVE E SUITE 201
SEATTLE WA
98112
US

IV. Provider business mailing address

6017 45TH AVENUE SW
SEATTLE WA
98136
US

V. Phone/Fax

Practice location:
  • Phone: 360-818-4000
  • Fax:
Mailing address:
  • Phone: 206-300-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC60257848
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60257848
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberMC60257848
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberMC60257848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: