Healthcare Provider Details

I. General information

NPI: 1821533035
Provider Name (Legal Business Name): LAUREN SHALANE WAGENDORF LMHC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN SHALANE HENRY LPCC

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16150 NE 85TH ST STE 121
REDMOND WA
98052-3542
US

IV. Provider business mailing address

1375 121ST AVE NE APT 208
BELLEVUE WA
98005-5069
US

V. Phone/Fax

Practice location:
  • Phone: 425-868-5777
  • Fax:
Mailing address:
  • Phone: 701-351-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC01367
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61000117
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: