Provider Demographics
NPI:1902296528
Name:GOMEZ, ALEX (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 102ND AVE NE STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4158
Mailing Address - Country:US
Mailing Address - Phone:425-200-5582
Mailing Address - Fax:720-554-8065
Practice Address - Street 1:826 102ND AVE NE STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4158
Practice Address - Country:US
Practice Address - Phone:425-200-5582
Practice Address - Fax:720-554-8065
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60293371101Y00000X
WALH60739452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor