Healthcare Provider Details

I. General information

NPI: 1972724524
Provider Name (Legal Business Name): LAURA SONGRAS-ROSALES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 GRIFFIN AVE
ENUMCLAW WA
98022-2369
US

IV. Provider business mailing address

3021 GRIFFIN AVE
ENUMCLAW WA
98022-2369
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-6511
  • Fax: 253-426-4322
Mailing address:
  • Phone: 360-825-6511
  • Fax: 253-426-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00010797
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60786825
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: