Provider Demographics
NPI:1548891708
Name:GERHART, LISA GAYLE (RBT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:GERHART
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13320 SE 181ST PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-6845
Mailing Address - Country:US
Mailing Address - Phone:206-235-7909
Mailing Address - Fax:
Practice Address - Street 1:17265 SE WAX RD STE 105
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-9102
Practice Address - Country:US
Practice Address - Phone:425-891-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17-36055106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician