Healthcare Provider Details

I. General information

NPI: 1528962446
Provider Name (Legal Business Name): MIRYAM GAONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W SPRUCE ST STE 30
YAKIMA WA
98902-3264
US

IV. Provider business mailing address

1111 W SPRUCE ST STE 30
YAKIMA WA
98902-3264
US

V. Phone/Fax

Practice location:
  • Phone: 509-631-8363
  • Fax: 509-430-9376
Mailing address:
  • Phone: 509-631-8363
  • Fax: 509-430-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70153651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: