Healthcare Provider Details

I. General information

NPI: 1497287445
Provider Name (Legal Business Name): LAURA EMMA MATHESON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 MAPLE AVE SW STE 220
RENTON WA
98057-3100
US

IV. Provider business mailing address

12638 SE 160TH ST
RENTON WA
98058-4718
US

V. Phone/Fax

Practice location:
  • Phone: 206-659-5504
  • Fax: 206-613-0866
Mailing address:
  • Phone: 206-819-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLF61188799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: