Individual
NICOLE GAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
4301 S PINE ST STE 505, TACOMA, WA 98409-7208
(253) 292-4354
Mailing address
8210 52ND STREET CT W, UNIVERSITY PLACE, WA 98467-1910
(626) 203-5419
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
1-18-34086
CO
Other
Enumeration date
09/25/2017
Last updated
10/17/2022
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