Provider Demographics
NPI:1821480336
Name:HOLE, GARY DOUGLAS (LMHCA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DOUGLAS
Last Name:HOLE
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35509 NE 91ST WAY
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-6862
Mailing Address - Country:US
Mailing Address - Phone:206-719-6438
Mailing Address - Fax:
Practice Address - Street 1:3310 E LAKE SAMMAMISH PKWY SE STE I
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7497
Practice Address - Country:US
Practice Address - Phone:425-677-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60490603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional