Provider Demographics
NPI:1316694631
Name:GATH, KAITLIN ANN (LMHCA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:GATH
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29425 232ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-1231
Mailing Address - Country:US
Mailing Address - Phone:206-853-4672
Mailing Address - Fax:
Practice Address - Street 1:1719 FELL ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3119
Practice Address - Country:US
Practice Address - Phone:206-853-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61165620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health