Provider Demographics
NPI:1528369931
Name:LAIBSON, JULIA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:LAIBSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 NE 128TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6314
Mailing Address - Country:US
Mailing Address - Phone:425-218-0745
Mailing Address - Fax:
Practice Address - Street 1:11415 NE 128TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6314
Practice Address - Country:US
Practice Address - Phone:425-218-0745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60209806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist