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1265210835
GAVIN DAVID KISEBACH
LACEY, WA
NPI
1265210835
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2023-09-15
Last Update Date
2023-09-15
Business Address
GAVIN DAVID KISEBACH
1034 ANNETTE CT SE
LACEY, WA 98503-1824
Phone number: 360-791-5826
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Mailing Address
GAVIN DAVID KISEBACH
1034 ANNETTE CT SE
LACEY, WA 98503-1824
Phone number: 360-791-5826
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