Healthcare Provider Details

I. General information

NPI: 1053828814
Provider Name (Legal Business Name): TWIN LAKES COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 SW 320TH ST
FEDERAL WAY WA
98023-2292
US

IV. Provider business mailing address

3430 SW 320TH ST STE D2
FEDERAL WAY WA
98023-2292
US

V. Phone/Fax

Practice location:
  • Phone: 253-289-6099
  • Fax: 253-330-8305
Mailing address:
  • Phone: 253-289-6099
  • Fax: 253-231-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAURA BETH WALLACE
Title or Position: OWNER
Credential: PHD, LMFT
Phone: 206-321-8555