Provider Demographics
NPI:1568992303
Name:AKHAVAN, LAURA MILLS (MA, CDP, LMHC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MILLS
Last Name:AKHAVAN
Suffix:
Gender:F
Credentials:MA, CDP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-6512
Mailing Address - Country:US
Mailing Address - Phone:360-786-9499
Mailing Address - Fax:360-786-0758
Practice Address - Street 1:2101 4TH AVE E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-6512
Practice Address - Country:US
Practice Address - Phone:360-786-9499
Practice Address - Fax:360-786-0758
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60215398101YA0400X
WAMC60235661101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)