Healthcare Provider Details

I. General information

NPI: 1871934117
Provider Name (Legal Business Name): GABRIEL GEBALLE ,MA, CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 02/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17018 15TH AVE NE
SHORELINE WA
98155-5126
US

IV. Provider business mailing address

17018 15TH AVE NE
SHORELINE WA
98155-5126
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-7282
  • Fax: 206-362-7152
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60156676
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: