Provider Demographics
NPI:1063700565
Name:GLEASON, ALICIA (MS, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 CALIFORNIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1513
Mailing Address - Country:US
Mailing Address - Phone:360-599-0331
Mailing Address - Fax:
Practice Address - Street 1:200 1ST AVE W
Practice Address - Street 2:SUITE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4298
Practice Address - Country:US
Practice Address - Phone:509-334-1133
Practice Address - Fax:509-332-1608
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60718127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health