Healthcare Provider Details

I. General information

NPI: 1750776456
Provider Name (Legal Business Name): MICHAEL LAUCKNER THOMAS LMHCA, MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 112TH ST E STE 215
PUYALLUP WA
98373-3206
US

IV. Provider business mailing address

5620 112TH ST E STE 215
PUYALLUP WA
98373-3206
US

V. Phone/Fax

Practice location:
  • Phone: 253-446-7176
  • Fax:
Mailing address:
  • Phone: 253-446-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61163620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: