Provider Demographics
NPI:1972975431
Name:GILBERT, TAMI LYNNE (MA)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:LYNNE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:LYNNE
Other - Last Name:GRAVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:20449 MICHIGAN HILL RD SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-9012
Mailing Address - Country:US
Mailing Address - Phone:541-760-1736
Mailing Address - Fax:
Practice Address - Street 1:1202 BLACK LAKE BLVD SW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-7208
Practice Address - Country:US
Practice Address - Phone:360-480-5721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103K00000X
WA61091134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst