Healthcare Provider Details

I. General information

NPI: 1528140415
Provider Name (Legal Business Name): NANCY LIEURANCE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N NORTHLAKE WAY STE 127
SEATTLE WA
98103-9051
US

IV. Provider business mailing address

1900 N NORTHLAKE WAY STE 127
SEATTLE WA
98103-9051
US

V. Phone/Fax

Practice location:
  • Phone: 206-706-0371
  • Fax: 206-420-4640
Mailing address:
  • Phone: 206-706-0371
  • Fax: 206-420-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLW00004688
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: