Provider Demographics
NPI:1144854332
Name:GAUL, LISA LORRAINE (SUDPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LORRAINE
Last Name:GAUL
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 4TH AVE EST
Mailing Address - Street 2:PO BOX 42
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-338-0600
Mailing Address - Fax:855-710-6500
Practice Address - Street 1:1905 4TH AVE E STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4631
Practice Address - Country:US
Practice Address - Phone:360-338-0600
Practice Address - Fax:855-710-6500
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60657437101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)