Healthcare Provider Details

I. General information

NPI: 1275599110
Provider Name (Legal Business Name): JENNIFER ANNE LAURVICK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 E MEAD AVE
YAKIMA WA
98903-3720
US

IV. Provider business mailing address

415 S 44TH ST
YAKIMA WA
98901-1508
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-1344
  • Fax:
Mailing address:
  • Phone: 509-576-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00009039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: