Provider Demographics
NPI:1780197921
Name:HASTINGS, MOLLY RAE (MS LMFT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:RAE
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GASCOIGNE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2407
Mailing Address - Country:US
Mailing Address - Phone:262-470-2382
Mailing Address - Fax:
Practice Address - Street 1:510 HARTBROOK DR STE 205
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1444
Practice Address - Country:US
Practice Address - Phone:262-470-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1406-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist