Provider Demographics
NPI:1821570573
Name:PRECIADO, LAURA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 LAKE TAPPS PKWY SE STE. F104-392
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8157
Mailing Address - Country:US
Mailing Address - Phone:206-588-6152
Mailing Address - Fax:206-260-7390
Practice Address - Street 1:1402 LAKE TAPPS PKWY SE STE. F104-392
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8157
Practice Address - Country:US
Practice Address - Phone:206-588-6152
Practice Address - Fax:206-260-7390
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60636204101YM0800X
WAPY.60911217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health