Provider Demographics
NPI:1558640763
Name:GALLOUPE, KATHRYN SUSANNE (LICSW-CDP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:SUSANNE
Last Name:GALLOUPE
Suffix:
Gender:F
Credentials:LICSW-CDP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:SUSANNE
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW-CDP
Mailing Address - Street 1:1233 120TH AVE NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2147
Mailing Address - Country:US
Mailing Address - Phone:425-450-9301
Mailing Address - Fax:425-450-9304
Practice Address - Street 1:1233 120TH AVE NE
Practice Address - Street 2:SUITE D
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2147
Practice Address - Country:US
Practice Address - Phone:425-450-9301
Practice Address - Fax:425-450-9304
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002510101YA0400X
WALW000096541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical