Provider Demographics
NPI:1922626704
Name:WILDE, LAUREN (LMHC, MA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WILDE
Suffix:
Gender:F
Credentials:LMHC, MA
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 3091
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98046-3091
Mailing Address - Country:US
Mailing Address - Phone:206-486-4658
Mailing Address - Fax:
Practice Address - Street 1:16150 NE 85TH ST STE 220
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3546
Practice Address - Country:US
Practice Address - Phone:206-486-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61034746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health