Provider Demographics
NPI:1144643552
Name:GABRIEL, ANN ELYSE (MED)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ELYSE
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:ELYSE
Other - Last Name:MERRIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3321 W KENNEWICK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2968
Mailing Address - Country:US
Mailing Address - Phone:509-783-2085
Mailing Address - Fax:509-735-6449
Practice Address - Street 1:3321 W KENNEWICK AVE STE 150
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-783-2085
Practice Address - Fax:509-735-6449
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60414174101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60657409OtherDEPARTMENT OF HEALTH