Individual
PETER PAUL LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3804 HASTINGS AVE W, PORT TOWNSEND, WA 98368-9642
(360) 385-5505
(360) 385-3605
Mailing address
PO BOX 102, PORT TOWNSEND, WA 98368-0102
(360) 385-5505
(360) 385-3605
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
CP00006346
WA
Other
Enumeration date
04/30/2014
Last updated
04/30/2014
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