Provider Demographics
NPI:1730305020
Name:LARUE, MARISA (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:LARUE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21619 SE 272ND LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-3271
Mailing Address - Country:US
Mailing Address - Phone:425-584-7051
Mailing Address - Fax:888-977-1762
Practice Address - Street 1:22142 SE 237TH ST STE 3
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8550
Practice Address - Country:US
Practice Address - Phone:425-584-7051
Practice Address - Fax:888-977-1762
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health