Provider Demographics
NPI:1386811321
Name:THEIN, LAURIE DANAE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:DANAE
Last Name:THEIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 E MAIN ST
Mailing Address - Street 2:PO BOX 155
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50630-7701
Mailing Address - Country:US
Mailing Address - Phone:563-237-5157
Mailing Address - Fax:319-865-3110
Practice Address - Street 1:123 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:IA
Practice Address - Zip Code:50630-7701
Practice Address - Country:US
Practice Address - Phone:563-237-5157
Practice Address - Fax:319-865-3110
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0203580Medicaid
IA1203580Medicaid