Provider Demographics
NPI:1265600274
Name:ONCKEN, GERALD R (PHD, RC)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:R
Last Name:ONCKEN
Suffix:
Gender:M
Credentials:PHD, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 198TH ST SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6738
Mailing Address - Country:US
Mailing Address - Phone:425-771-1914
Mailing Address - Fax:425-771-0127
Practice Address - Street 1:4215 198TH ST SW
Practice Address - Street 2:SUITE 102
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6738
Practice Address - Country:US
Practice Address - Phone:425-771-1914
Practice Address - Fax:425-771-0127
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00017576101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA409764OtherVALUE OPTIONS
WA7788573OtherAETNA
WA305165OtherMHN