Provider Demographics
NPI:1063420123
Name:LAZICH, MARK (MS, LMHC, LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LAZICH
Suffix:
Gender:M
Credentials:MS, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 E ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3007
Mailing Address - Country:US
Mailing Address - Phone:360-734-2664
Mailing Address - Fax:
Practice Address - Street 1:1513 E ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3007
Practice Address - Country:US
Practice Address - Phone:360-734-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8481101YM0800X
ORC1666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional