Provider Demographics
NPI:1356782528
Name:FAMILY RENEWAL
Entity type:Organization
Organization Name:FAMILY RENEWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:425-647-5775
Mailing Address - Street 1:2015 NE 96TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-2980
Mailing Address - Country:US
Mailing Address - Phone:425-647-5775
Mailing Address - Fax:360-340-9353
Practice Address - Street 1:2015 NE 96TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2980
Practice Address - Country:US
Practice Address - Phone:425-647-5775
Practice Address - Fax:360-340-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60550441101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty