| Doctor Name: | ALICIA GLEASON |
| NPI Number: | 1063700565 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | MC60507307 |
| Business Practice Address: | 340 Ne Maple St Pullman, WA - 991634120 |
| Business Phone Number: | 5093341133 |
| Business Fax Number: | 5093321608 |
| Mailing Address: | 442 Se Kamiaken St, PULLMAN |
| State: | WA |
| Postal Code: | 991632522 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/18/2011 |
| NPI Last Update Date: | 12/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MC60507307 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |