Provider Demographics
NPI:1235565672
Name:LASLEY, TRACEY JEAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:JEAN
Last Name:LASLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:JEAN
Other - Last Name:ENSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3857 MARTIN WAY E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5268
Mailing Address - Country:US
Mailing Address - Phone:360-704-7170
Mailing Address - Fax:
Practice Address - Street 1:3857 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5268
Practice Address - Country:US
Practice Address - Phone:360-704-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60414889101Y00000X, 101YM0800X
WALH60561548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor