Provider Demographics
NPI:1083231955
Name:VAN HORN, LAURA LANE'E (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LANE'E
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LAN'E
Other - Last Name:PEYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:104 N WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175-1349
Mailing Address - Country:US
Mailing Address - Phone:563-412-9348
Mailing Address - Fax:
Practice Address - Street 1:18569 LANE RD
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-9525
Practice Address - Country:US
Practice Address - Phone:563-422-5606
Practice Address - Fax:563-422-5607
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health