Provider Demographics
NPI:1689641896
Name:LAUGHLIN, JOHN W (PA, LMHC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:LAUGHLIN
Suffix:
Gender:M
Credentials:PA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0057
Mailing Address - Country:US
Mailing Address - Phone:509-682-4120
Mailing Address - Fax:
Practice Address - Street 1:238 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2105
Practice Address - Country:US
Practice Address - Phone:509-587-6935
Practice Address - Fax:509-293-7728
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006775101YM0800X
WAPA10000728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2149942Medicaid