MEDICARE: JESSICA GAUL LMHC

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	LH60825234	WA

General Provider Information

NPI Number	:	1730544164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GAUL LMHC

Provider Business Mailing Address
First Line	:	4055 SW MYRTLE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1933
Country	:	US
Telephone Number	:	206-618-3728
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 SW MYRTLE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1933
Country	:	US
Telephone Number	:	206-618-3728
Fax Number	:

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

Provider Enumeration Date	:	12/30/2015
Last Update Date	:	08/19/2021

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