Provider Demographics
NPI:1780719351
Name:GATES, JOSHUA DAVID
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:GATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1781
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0380
Mailing Address - Country:US
Mailing Address - Phone:253-848-3249
Mailing Address - Fax:253-864-8954
Practice Address - Street 1:3908 10TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2188
Practice Address - Country:US
Practice Address - Phone:253-848-3249
Practice Address - Fax:253-864-8954
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7006OtherFCHN