Provider Demographics
NPI:1619021011
Name:WASH, GAYLE ARLENE (MS LCPC)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ARLENE
Last Name:WASH
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-248-6010
Mailing Address - Fax:406-245-2441
Practice Address - Street 1:304 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-248-6010
Practice Address - Fax:406-245-2441
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
236710OtherVALUE OPT
075431OtherBCBS
MT0252148Medicaid