Provider Demographics
NPI:1699119115
Name:GATES, GREGORY RUSSELL (MA, LMHC, CDP, MHP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:RUSSELL
Last Name:GATES
Suffix:
Gender:M
Credentials:MA, LMHC, CDP, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33309 1ST WAY S
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6260
Mailing Address - Country:US
Mailing Address - Phone:253-952-2556
Mailing Address - Fax:253-952-6356
Practice Address - Street 1:33309 1ST WAY S
Practice Address - Street 2:SUITE 203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6260
Practice Address - Country:US
Practice Address - Phone:253-952-2556
Practice Address - Fax:253-952-6356
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60039687101YA0400X
WALH 60074511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)