Provider Demographics
NPI:1134871916
Name:GAIL A TRUITT LICSW COUNSELING SERVICES S CORP
Entity type:Organization
Organization Name:GAIL A TRUITT LICSW COUNSELING SERVICES S CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:253-630-5434
Mailing Address - Street 1:27121 174TH PL SE STE 100
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4939
Mailing Address - Country:US
Mailing Address - Phone:253-630-5434
Mailing Address - Fax:253-638-7465
Practice Address - Street 1:27121 174TH PL SE STE 100
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4939
Practice Address - Country:US
Practice Address - Phone:253-630-5434
Practice Address - Fax:253-638-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-22
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033283577OtherINDIVIDUAL NPI