Provider Demographics
NPI:1962925123
Name:GAGE, MARY LOU (MA, LMHC, CDPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:GAGE
Suffix:
Gender:
Credentials:MA, LMHC, CDPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LOU
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:8810 202ND PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6636
Mailing Address - Country:US
Mailing Address - Phone:425-320-9974
Mailing Address - Fax:
Practice Address - Street 1:21701 76TH AVE W
Practice Address - Street 2:STE. 301
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6200
Practice Address - Country:US
Practice Address - Phone:425-472-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60910944101YA0400X
WALH00008392101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023515400Medicaid