Healthcare Provider Details

I. General information

NPI: 1043420318
Provider Name (Legal Business Name): ELLEN JANELL GILBO M.S. C.C., CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLEN JANELL JEFFCOAT CMHP, CBHP

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 ST HELENS AVE
TACOMA WA
98402-3706
US

IV. Provider business mailing address

2113 BURNETT PL S
RENTON WA
98055-5042
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-0484
  • Fax: 253-274-1457
Mailing address:
  • Phone: 904-613-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60088744
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: