Provider Demographics
NPI:1568125433
Name:HERNANDEZ GARCILAZO, GABRIELA (LMHCA)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:HERNANDEZ GARCILAZO
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4741
Mailing Address - Country:US
Mailing Address - Phone:620-339-1559
Mailing Address - Fax:
Practice Address - Street 1:707 S GRADY WAY STE 300
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3245
Practice Address - Country:US
Practice Address - Phone:425-226-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61018019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health