Provider Demographics
NPI:1255648663
Name:MIJAL, LAURA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:MIJAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 143RD ST SW
Mailing Address - Street 2:B
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-4883
Mailing Address - Country:US
Mailing Address - Phone:360-220-4994
Mailing Address - Fax:
Practice Address - Street 1:2631 143RD ST SW
Practice Address - Street 2:B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-4883
Practice Address - Country:US
Practice Address - Phone:360-220-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist