Provider Demographics
NPI:1205300316
Name:GEHLBACH-WILSON, DAVID (LSWAIC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GEHLBACH-WILSON
Suffix:
Gender:M
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 12TH AVE S # 98144
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2007
Mailing Address - Country:US
Mailing Address - Phone:206-324-9360
Mailing Address - Fax:
Practice Address - Street 1:611 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2007
Practice Address - Country:US
Practice Address - Phone:206-552-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health