Provider Demographics
NPI:1568868941
Name:GERSON, TODD (MSW, LMHC, LAICSW)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:GERSON
Suffix:
Gender:M
Credentials:MSW, LMHC, LAICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 E YALE AVE APT 216
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6958
Mailing Address - Country:US
Mailing Address - Phone:248-504-8722
Mailing Address - Fax:
Practice Address - Street 1:7100 FORT DENT WAY STE 220
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8553
Practice Address - Country:US
Practice Address - Phone:248-504-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246Z00000X
WALH61010289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other