Provider Demographics
NPI:1174990717
Name:LAVENTURE, RENE
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:LAVENTURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MCKENZIE AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7003
Mailing Address - Country:US
Mailing Address - Phone:360-441-5724
Mailing Address - Fax:
Practice Address - Street 1:2569 MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9204
Practice Address - Country:US
Practice Address - Phone:360-441-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60351528101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health