Provider Demographics
NPI:1063658326
Name:DEATS, LAWRENCE MATTHEW (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MATTHEW
Last Name:DEATS
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3910
Mailing Address - Country:US
Mailing Address - Phone:360-244-2982
Mailing Address - Fax:
Practice Address - Street 1:705 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3910
Practice Address - Country:US
Practice Address - Phone:360-244-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60045201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health