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General NPI Number Information
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NPI Number | 1356782528
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Entity Type | Organization
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Legal Business Name | FAMILY RENEWAL
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 2015 NE 96TH CT
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City | VANCOUVER
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State | WA
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Zip | 98664-2980
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Country | US
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Telephone | 425-647-5775
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Fax | 360-340-9353
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Provider Business Mailing Address
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Address Line | 2015 NE 96TH CT
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City | VANCOUVER
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State | WA
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Zip | 98664-2980
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Country | US
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Telephone | 425-647-5775
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Fax | 360-340-9353
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE LAURENT
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Credential | LMHC
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Telephone | 425-647-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60550441
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License Number State | WA
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