Provider Demographics
NPI:1326383654
Name:HARTELIUS, LORI (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HARTELIUS
Suffix:
Gender:F
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 1:512 91ST AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2566
Mailing Address - Country:US
Mailing Address - Phone:425-268-3389
Mailing Address - Fax:
Practice Address - Street 1:512 91ST AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2566
Practice Address - Country:US
Practice Address - Phone:425-268-3389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH0006589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health