Provider Demographics
NPI:1750776456
Name:THOMAS, MICHAEL LAUCKNER (LMHCA, MT-BC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LAUCKNER
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMHCA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 112TH ST E STE 215
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3206
Mailing Address - Country:US
Mailing Address - Phone:253-446-7176
Mailing Address - Fax:
Practice Address - Street 1:5620 112TH ST E STE 215
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3206
Practice Address - Country:US
Practice Address - Phone:253-446-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
WAMC61163620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist