MEDICARE: LAUREL SUE LUM MA

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	101Y00000X	Counselor	MC60386623	WA

General Provider Information

NPI Number	:	1902189475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL SUE LUM MA

Provider Business Mailing Address
First Line	:	2366 EASTLAKE AVE E STE 320
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3399
Country	:	US
Telephone Number	:	206-931-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	4312 BAKER AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4349
Country	:	US
Telephone Number	:	206-931-5673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	12/20/2013

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