Provider Demographics
NPI:1588997795
Name:LAUTERBACH, AMY LYN (LMLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:LAUTERBACH
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYN
Other - Last Name:HARBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-0677
Mailing Address - Country:US
Mailing Address - Phone:913-557-9096
Mailing Address - Fax:913-294-9247
Practice Address - Street 1:25955 W 327TH ST
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-4920
Practice Address - Country:US
Practice Address - Phone:913-557-9096
Practice Address - Fax:913-294-9247
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP 1338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health