Healthcare Provider Details

I. General information

NPI: 1457193542
Provider Name (Legal Business Name): HEATHER KATHLEEN GAMBLE MS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 MAIN ST STE 205
VANCOUVER WA
98663-2235
US

IV. Provider business mailing address

3606 MAIN ST STE 205
VANCOUVER WA
98663-2235
US

V. Phone/Fax

Practice location:
  • Phone: 360-200-8670
  • Fax:
Mailing address:
  • Phone: 360-200-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61548260
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: