Provider Demographics
NPI:1013301456
Name:GRANGER, LAUREL (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:GRANGER
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 1:1900 S PUGET DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-4421
Mailing Address - Country:US
Mailing Address - Phone:425-736-1604
Mailing Address - Fax:
Practice Address - Street 1:1900 S PUGET DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4421
Practice Address - Country:US
Practice Address - Phone:425-736-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60441308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health