Healthcare Provider Details

I. General information

NPI: 1205585593
Provider Name (Legal Business Name): LAUREN QUALLS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 216TH ST SW
MOUNTLAKE TERRACE WA
98043-2089
US

IV. Provider business mailing address

9407 NE VANCOUVER MALL DR, STE 104 #684
VANCOUVER WA
98662
US

V. Phone/Fax

Practice location:
  • Phone: 719-822-1222
  • Fax:
Mailing address:
  • Phone: 217-971-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61660782
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMC61139123
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: