Provider Demographics
NPI:1932748993
Name:LAURENTZ, ERIKA ANNE (MPSYCH)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:ANNE
Last Name:LAURENTZ
Suffix:
Gender:F
Credentials:MPSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SLEATER KINNEY RD. SE
Mailing Address - Street 2:BOX B-269
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-280-8658
Mailing Address - Fax:
Practice Address - Street 1:914 S SCHEUBER RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9027
Practice Address - Country:US
Practice Address - Phone:360-827-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-22
Last Update Date:2019-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60994616101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor