Provider Demographics
NPI:1013295765
Name:LAWRENCE, STACEY (LMP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 59TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2858
Mailing Address - Country:US
Mailing Address - Phone:253-581-7020
Mailing Address - Fax:
Practice Address - Street 1:9330 59TH AVENUE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-6600
Practice Address - Country:US
Practice Address - Phone:253-581-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WAMA00013047225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist