1245674829 NPI number — LAURA J HAVENS LMFT LMHC

Table of content: LAURA J HAVENS LMFT LMHC (NPI 1245674829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245674829 NPI number — LAURA J HAVENS LMFT LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAVENS
Provider First Name:
LAURA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COSTELLO
Provider Other First Name:
LAURA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245674829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
814 S PEABODY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ANGELES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98362-7906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-460-0217
Provider Business Mailing Address Fax Number:
360-406-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
814 S PEABODY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ANGELES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98362-7906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-460-0217
Provider Business Practice Location Address Fax Number:
360-406-8688
Provider Enumeration Date:
04/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LF60805478 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: LH60527932 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2047063 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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