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General NPI Number Information
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NPI Number | 1124816558
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Entity Type | Organization
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Legal Business Name | LG PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 04/26/2025
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 677 WOODLAND SQUARE LOOP SE STE B6
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City | LACEY
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State | WA
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Zip | 98503-1000
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Country | US
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Telephone | 360-585-4050
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Fax | 360-282-1013
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Provider Business Mailing Address
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Address Line | 6642 STONE ST SE
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City | LACEY
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State | WA
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Zip | 98513-4961
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Country | US
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Telephone | 360-701-7281
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KRISTIN ROCHELE GAYLE
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Credential | PHD
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Telephone | 360-701-7281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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