Jeremy Kyle Gardner, M.S., LMFT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LF60101296 Issued in WA

Practice address

1356 Cole St
Enumclaw, WA 98022-2633

Phone

(360) 802-6492

Fax

(360) 802-5114

NPI assigned

Feb 17, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1942522966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 COLE ST",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222633",
            "telephone_number": "360-802-6492",
            "fax_number": "360-802-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 COLE ST",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222633",
            "telephone_number": "360-802-6492",
            "fax_number": "360-802-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JEREMY",
        "middle_name": "KYLE",
        "credential": "M.S., LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-02-17",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LF60101296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "12607 SE Mill Plain Blvd",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986846055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jill Anne Fullerton, RPH
• Kristina Renee Furbush
• Dawn Cathleen Gallagher Szylwin, RPH
• Nidia Gamez, NURSE
• Kalin Huddleston Garcia, EAME (L.AC.)
• Kaitlin Ann Gath, LMHCA
• Berhan Ghermay, M.D.
• Megan Renae Gifford, CDP, CD(DONA)
• Nicola Given, CNM ARNP
• Colleen Goethals, LMT

• Mental Health Counselor in Enumclaw, WA
• Providers in Enumclaw, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.