Provider Demographics
NPI:1871948224
Name:GILLIS, AZARAH ROSE (LMHC)
Entity type:Individual
Prefix:MS
First Name:AZARAH
Middle Name:ROSE
Last Name:GILLIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 112TH AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6901
Mailing Address - Country:US
Mailing Address - Phone:425-245-5981
Mailing Address - Fax:425-225-7487
Practice Address - Street 1:310 3RD AVE NE STE 112
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3347
Practice Address - Country:US
Practice Address - Phone:425-245-5981
Practice Address - Fax:425-225-7487
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61005663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional