Provider Demographics
NPI:1659425528
Name:MANAHAN, GAIL A (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:A
Last Name:MANAHAN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258
Mailing Address - Country:US
Mailing Address - Phone:425-327-2031
Mailing Address - Fax:425-397-8644
Practice Address - Street 1:512 91ST AVE NE
Practice Address - Street 2:UNIT C
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98205-1566
Practice Address - Country:US
Practice Address - Phone:425-327-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health