Individual
BRETTYN CAROLE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
309 W 12TH ST, VANCOUVER, WA 98660-2903
(360) 334-5575
(360) 695-9803
Mailing address
309 W 12TH ST, VANCOUVER, WA 98660-2903
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
61000756
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1980234
—
WA
Enumeration date
09/11/2018
Last updated
09/17/2020
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