Provider Demographics
NPI:1871934117
Name:GEBALLE, GABRIEL (,MA, CDP)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:GEBALLE
Suffix:
Gender:M
Credentials:,MA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17018 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17018 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5126
Practice Address - Country:US
Practice Address - Phone:206-362-7282
Practice Address - Fax:206-362-7152
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60156676101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)