Provider Demographics
NPI:1568984813
Name:GILLIN, ROBERTA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:GILLIN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:
Other - Last Name:GILLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:800 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4828
Mailing Address - Country:US
Mailing Address - Phone:206-353-8766
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 213
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6978
Practice Address - Country:US
Practice Address - Phone:206-353-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60731391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health