MEDICARE: LAUREL COUNSELING SERVICES L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	LH60647512	WA

General Provider Information

NPI Number	:	1437607553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL COUNSELING SERVICES L.L.C.

Provider Business Mailing Address
First Line	:	1031 W 12TH AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99204-3815
Country	:	US
Telephone Number	:	970-209-5371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 S GRAND BLVD
Second Line	:	201
City	:	SPOKANE
State	:	WA
Zip	:	99203-5001
Country	:	US
Telephone Number	:	970-209-5371
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HOLLY L P CANNARD
Credential	:	LMHC
Telephone Number	:	970-209-5371

Provider Enumeration Date	:	09/18/2016
Last Update Date	:	09/18/2016

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