Provider Demographics
NPI:1336415744
Name:AHN, LAURA (MA LMHCA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:AHN
Suffix:
Gender:F
Credentials:MA LMHCA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:304 MAIN AVE S
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2758
Practice Address - Country:US
Practice Address - Phone:206-552-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60270792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health