Provider Demographics
NPI:1285250449
Name:GIBRANO, YAKITA TRENISSIA
Entity type:Individual
Prefix:MISS
First Name:YAKITA
Middle Name:TRENISSIA
Last Name:GIBRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 SE 171ST WAY APT T4
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8741
Mailing Address - Country:US
Mailing Address - Phone:206-293-0661
Mailing Address - Fax:
Practice Address - Street 1:EVERGREEN TREATMENT SERVICES
Practice Address - Street 2:1700 AIRPORT WAY S
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1618
Practice Address - Country:US
Practice Address - Phone:206-223-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor