Provider Demographics
NPI:1497036164
Name:SCHWISOW, LAURIE JEAN (LMHC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:SCHWISOW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 SE BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-8641
Mailing Address - Country:US
Mailing Address - Phone:360-878-5667
Mailing Address - Fax:
Practice Address - Street 1:1204 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4277
Practice Address - Country:US
Practice Address - Phone:360-878-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health