Healthcare Provider Details

I. General information

NPI: 1932876430
Provider Name (Legal Business Name): LAURALAI DANIELLE FALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 160TH ST S STE 101
SPANAWAY WA
98387-8508
US

IV. Provider business mailing address

2904 S EDISON PL
KENNEWICK WA
99338-2713
US

V. Phone/Fax

Practice location:
  • Phone: 253-881-9854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70091877
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61510531
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: