Healthcare Provider Details

I. General information

NPI: 1104465152
Provider Name (Legal Business Name): LAURA AUBERT LMHC, SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 VASSAR DR SE
ALBUQUERQUE NM
87106-2959
US

IV. Provider business mailing address

280 E SHAMROCK DR
SHELTON WA
98584-7520
US

V. Phone/Fax

Practice location:
  • Phone: 505-544-3898
  • Fax:
Mailing address:
  • Phone: 505-544-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.61506191
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: