Provider Demographics
NPI:1184904476
Name:CAPITOL LAKE COUNSELING
Entity type:Organization
Organization Name:CAPITOL LAKE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:360-259-4500
Mailing Address - Street 1:1211 4TH AVE E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4279
Mailing Address - Country:US
Mailing Address - Phone:360-259-4500
Mailing Address - Fax:
Practice Address - Street 1:1211 4TH AVE E
Practice Address - Street 2:SUITE 200
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4279
Practice Address - Country:US
Practice Address - Phone:360-259-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty