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General NPI Number Information
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NPI Number | 1821480336
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Entity Type | Individual
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Provider Name | GARY DOUGLAS HOLE LMHCA
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Gender | Male
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Dates
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Enumeration Date | 02/21/2015
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Last Update Date | 02/21/2015
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Provider Practice Location Address
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Address Line | 3310 E LAKE SAMMAMISH PKWY SE STE I
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City | SAMMAMISH
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State | WA
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Zip | 98075-7497
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Country | US
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Telephone | 425-677-8403
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Fax |
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Provider Business Mailing Address
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Address Line | 35509 NE 91ST WAY
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City | CARNATION
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State | WA
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Zip | 98014-6862
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Country | US
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Telephone | 206-719-6438
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MC 60490603
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License Number State | WA
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