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Gavin David Kisebach
Mental Health Counselor in Lacey, Washington
NPI 1265210835

Gavin David Kisebach is a Mental Health Counselor based in Lacey, WA and is specialized in Mental Health. Gavin David Kisebach practices in Lacey, WA. The NPI Number for Gavin David Kisebach is 1265210835 and holds a License No. (Washington).

The current practice location address for Gavin David Kisebach is 1034 Annette Ct Se, Lacey, WA and can be reached out via phone at 360-791-5826.

Location: 1034 Annette Ct Se, Lacey, WA, 98503-1824
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1265210835
Provider Name
Gavin David Kisebach
Credential
Provider Entity Type
Individual
Gender
Male
Address
1034 Annette Ct Se, Lacey, WA, 98503-1824
Phone Number
360-791-5826
Fax Number
Provider Enumeration Date
09/15/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1034 Annette Ct Se
City
Lacey
State
Washington
Zip
98503-1824
Phone Number
360-791-5826
Fax Number
person
Provider Business Mailing Address Details
Address
1034 Annette Ct Se
City
Lacey
State
Washington
Zip
98503-1824
Phone Number
360-791-5826
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
(Washington)
Definition
Definition to come...
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