Provider Demographics
NPI:1790119295
Name:LAUTENBACH, NANCY LYNNE (MA, LMHC, ATR)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNNE
Last Name:LAUTENBACH
Suffix:
Gender:F
Credentials:MA, LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 ALA MOANA BLVD APT 310
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5420
Mailing Address - Country:US
Mailing Address - Phone:808-866-3405
Mailing Address - Fax:
Practice Address - Street 1:680 ALA MOANA BLVD APT 310
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5420
Practice Address - Country:US
Practice Address - Phone:808-866-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HI755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health