Provider Demographics
NPI:1457043580
Name:HAINES, LAURA S (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:HAINES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1527
Mailing Address - Country:US
Mailing Address - Phone:573-881-3272
Mailing Address - Fax:
Practice Address - Street 1:800 E SPRING ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1527
Practice Address - Country:US
Practice Address - Phone:573-881-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013010487101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor