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General NPI Number Information
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NPI Number | 1457824401
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Entity Type | Organization
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Legal Business Name | LANDSTROM COUNSELING, LLC
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Dates
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Enumeration Date | 01/02/2019
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 1311 BONNEVILLE AVE STE 204
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City | SNOHOMISH
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State | WA
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Zip | 98290-2087
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Country | US
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Telephone | 425-344-6058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1596
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City | MONROE
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State | WA
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Zip | 98272-4596
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Country | US
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Telephone | 425-905-7089
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA LANDSTROM
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Credential | MS, LMHC
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Telephone | 425-905-7089
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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 |
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License Number State |
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