Theodore R. Liautaud | |
421 E Shore Dr Lake View IA 51450 | |
(712) 657-2211 | |
(712) 657-2106 |
Full Name | Theodore R. Liautaud |
---|---|
Speciality | Counselor - Mental Health |
Location | 421 E Shore Dr, Lake View, Iowa |
Authorized Official Name and Position | Theodore R. Liautaud (OWNER) |
Authorized Official Contact | 7126572211 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Theodore R. Liautaud Po Box 710 421 E Shore Dr Lake View IA 51450 Ph: (712) 657-2211 | Theodore R. Liautaud 421 E Shore Dr Lake View IA 51450 Ph: (712) 657-2211 |
NPI Number | 1487779575 |
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Provider Enumeration Date | 03/20/2007 |
Last Update Date | 09/30/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487779575 | NPI | - | NPPES |
0287888 | Medicaid | IA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | 01790 (Iowa) | Secondary |
101YM0800X | Counselor - Mental Health | 01790 (Iowa) | Primary |