Provider Demographics
NPI:1972855583
Name:ENGELBECK, LAURIE MARIE (PHD,, NCSP)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MARIE
Last Name:ENGELBECK
Suffix:
Gender:F
Credentials:PHD,, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 228TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9208
Mailing Address - Country:US
Mailing Address - Phone:425-837-5711
Mailing Address - Fax:425-837-5762
Practice Address - Street 1:3200 228TH AVE SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-9208
Practice Address - Country:US
Practice Address - Phone:425-837-5711
Practice Address - Fax:425-837-5762
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 2056103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical