Provider Demographics
NPI:1851568406
Name:GIST, ERIN KATHLEEN (MA, LMHC, CMHS)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:KATHLEEN
Last Name:GIST
Suffix:
Gender:F
Credentials:MA, LMHC, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 113TH AVE NE STE 210
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6950
Mailing Address - Country:US
Mailing Address - Phone:425-502-5641
Mailing Address - Fax:
Practice Address - Street 1:12220 113TH AVE NE STE 210
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6950
Practice Address - Country:US
Practice Address - Phone:425-502-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60214683101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor