Provider Demographics
NPI:1952080681
Name:GOLD, BRETT GARY (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:GARY
Last Name:GOLD
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 S 156TH ST
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2746
Mailing Address - Country:US
Mailing Address - Phone:206-954-5572
Mailing Address - Fax:
Practice Address - Street 1:4406 S 156TH ST
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2746
Practice Address - Country:US
Practice Address - Phone:206-954-5572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALC00004341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health