Provider Demographics
NPI:1619964483
Name:INGEBRITSEN, LAURIE M (MS LCPC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:M
Last Name:INGEBRITSEN
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N SPOKANE ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7016
Mailing Address - Country:US
Mailing Address - Phone:208-777-8500
Mailing Address - Fax:208-777-8721
Practice Address - Street 1:306 N SPOKANE ST
Practice Address - Street 2:SUITE I
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7016
Practice Address - Country:US
Practice Address - Phone:208-777-8500
Practice Address - Fax:208-777-8721
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional