Basic Information
| Provider Information | |||||||||
| NPI: | 1972724524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONGRAS-ROSALES | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3021 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980222369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608256511 | ||||||||
| FaxNumber: | 2534264322 | ||||||||
| Practice Location | |||||||||
| Address1: | 3021 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980222369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608256511 | ||||||||
| FaxNumber: | 2534264322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00010797 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 363LP0808X | AP60786825 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2090172 | 05 | WA | MEDICAID |