Provider Demographics
NPI:1043420318
Name:GILBO, ELLEN JANELL (MS CC, CDP)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:JANELL
Last Name:GILBO
Suffix:
Gender:F
Credentials:MS CC, CDP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:JANELL
Other - Last Name:JEFFCOAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMHP, CBHP
Mailing Address - Street 1:2113 BURNETT PL S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5042
Mailing Address - Country:US
Mailing Address - Phone:904-613-5375
Mailing Address - Fax:
Practice Address - Street 1:758 ST HELENS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3706
Practice Address - Country:US
Practice Address - Phone:253-274-0484
Practice Address - Fax:253-274-1457
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YA0400X
WACP60088744101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)