Provider Demographics
NPI:1447605399
Name:LUBAHN, KAITLIN (T-LMFT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:LUBAHN
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W WATER ST STE A2
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1806
Mailing Address - Country:US
Mailing Address - Phone:319-213-3534
Mailing Address - Fax:
Practice Address - Street 1:120 W WATER ST STE A2
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1806
Practice Address - Country:US
Practice Address - Phone:319-213-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist