Provider Demographics
NPI:1093560773
Name:LAUTENBACH, HALEY ROSE (LPCA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ROSE
Last Name:LAUTENBACH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9234 WENDELL CIR APT 34
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1647
Mailing Address - Country:US
Mailing Address - Phone:502-396-8392
Mailing Address - Fax:
Practice Address - Street 1:9234 WENDELL CIR APT 34
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-1647
Practice Address - Country:US
Practice Address - Phone:502-435-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287756101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health