| 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 |
|---|---|
| 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 |