Healthcare Provider Details

I. General information

NPI: 1548701055
Provider Name (Legal Business Name): BARBARANN GABRIELLE KUIK LMFTA, PHD-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15310 92ND AVE SE STE 2
YELM WA
98597-8210
US

IV. Provider business mailing address

15310 92ND AVE SE STE 2
YELM WA
98597-8210
US

V. Phone/Fax

Practice location:
  • Phone: 719-237-1833
  • Fax: 719-237-1833
Mailing address:
  • Phone: 719-237-1833
  • Fax: 719-237-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61401812.
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: