Healthcare Provider Details

I. General information

NPI: 1083982730
Provider Name (Legal Business Name): MS. LAURA LEE PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 14TH AVE
LONGVIEW WA
98632-2316
US

IV. Provider business mailing address

102 SHERWOOD LN
CASTLE ROCK WA
98611-9462
US

V. Phone/Fax

Practice location:
  • Phone: 360-423-0203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC 60173392
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: