Provider Demographics
NPI:1366628588
Name:LAWRENCE, JOHN ERIC (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ERIC
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 BREMERTON PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4763
Mailing Address - Country:US
Mailing Address - Phone:425-271-1166
Mailing Address - Fax:
Practice Address - Street 1:724 BREMERTON PL NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4763
Practice Address - Country:US
Practice Address - Phone:425-271-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60034337103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral