Healthcare Provider Details

I. General information

NPI: 1245674829
Provider Name (Legal Business Name): LAURA J HAVENS LMFT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA J COSTELLO LMFT LMHC

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 S PEABODY ST
PORT ANGELES WA
98362-7906
US

IV. Provider business mailing address

814 S PEABODY ST
PORT ANGELES WA
98362-7906
US

V. Phone/Fax

Practice location:
  • Phone: 360-460-0217
  • Fax: 360-406-8688
Mailing address:
  • Phone: 360-460-0217
  • Fax: 360-406-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60527932
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60805478
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: