Provider Demographics
NPI:1831615822
Name:GEBBEN, PAUL (LMHC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GEBBEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 169TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6542
Mailing Address - Country:US
Mailing Address - Phone:616-214-0818
Mailing Address - Fax:
Practice Address - Street 1:100 2ND AVE S STE 140
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-8439
Practice Address - Country:US
Practice Address - Phone:616-214-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60757154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health