MEDICARE: KASEY GAMBLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1073442455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY GAMBLE

Provider Business Mailing Address
First Line	:	1421 18TH PL SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-6801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3921 MINNESOTA AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-2662
Country	:	US
Telephone Number	:	202-839-5310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “ KASEY GAMBLE ” Practice Location

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