Healthcare Provider Details

I. General information

NPI: 1548728744
Provider Name (Legal Business Name): CARMEN LASBY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 112TH AVE NE STE 200
BELLEVUE WA
98004-2945
US

IV. Provider business mailing address

PO BOX 60223
RENTON WA
98058-3223
US

V. Phone/Fax

Practice location:
  • Phone: 253-642-6358
  • Fax:
Mailing address:
  • Phone: 253-642-6358
  • Fax: 425-207-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARMEN DANIELLE LASBY
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSYD
Phone: 253-642-6358