Provider Demographics
NPI:1669888590
Name:LAZARO, MARILYN LITTA (LMHC, NCC, SUDP)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:LITTA
Last Name:LAZARO
Suffix:
Gender:F
Credentials:LMHC, NCC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 166TH AVE NE UNIT A102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3789
Mailing Address - Country:US
Mailing Address - Phone:757-286-0333
Mailing Address - Fax:
Practice Address - Street 1:8545 166TH AVE NE UNIT A102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3789
Practice Address - Country:US
Practice Address - Phone:757-286-0333
Practice Address - Fax:425-963-0551
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60815936101Y00000X, 101YM0800X
WACP60819458101YA0400X
NY31074101YA0400X
NY008277-1101YM0800X
VA0701009808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2170428Medicaid