Healthcare Provider Details

I. General information

NPI: 1265012884
Provider Name (Legal Business Name): GABRIELLA M LUTHER BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY STE 204
TACOMA WA
98402-3900
US

IV. Provider business mailing address

401 BROADWAY STE 204
TACOMA WA
98402-3900
US

V. Phone/Fax

Practice location:
  • Phone: 253-271-8452
  • Fax:
Mailing address:
  • Phone: 253-271-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSYC.PY.70001985
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: