Healthcare Provider Details

I. General information

NPI: 1366213977
Provider Name (Legal Business Name): KIRSTEN KOLEA LAUREL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 MCLEOD DR STE 100
LAS VEGAS NV
89121-2257
US

IV. Provider business mailing address

3225 MCLEOD DR STE 100
LAS VEGAS NV
89121-2257
US

V. Phone/Fax

Practice location:
  • Phone: 425-655-7151
  • Fax:
Mailing address:
  • Phone: 425-655-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: