Provider Demographics
NPI:1871919456
Name:MARK, LAWRENCE (LMFT)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:MARK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 121ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-2827
Mailing Address - Country:US
Mailing Address - Phone:206-271-4768
Mailing Address - Fax:
Practice Address - Street 1:330 112TH AVE NE
Practice Address - Street 2:SUITE 302
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5800
Practice Address - Country:US
Practice Address - Phone:206-271-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00001243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist