Healthcare Provider Details

I. General information

NPI: 1043247166
Provider Name (Legal Business Name): LISA MAARI FLADAGER LMHC, R-DMT, CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 E. MEINHOLD RD.
LANGLEY WA
98260-0861
US

IV. Provider business mailing address

PO BOX 861 2812 E. MEINHOLD RD.
LANGLEY WA
98260-0861
US

V. Phone/Fax

Practice location:
  • Phone: 360-221-2677
  • Fax:
Mailing address:
  • Phone: 360-221-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00006356
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: