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Organization

THEODORE R. LIAUTAUD

Active
Other names
Lakes Counseling & Psychiatry
Organization subpart
No

Provider details

NPI number
Authorized official
THEODORE R. LIAUTAUD DO (OWNER)
(712) 657-2211
Entity
Organization

Contact information

Practice address
421 E SHORE DR, LAKE VIEW, IA 51450
(712) 657-2211
(712) 657-2106
Mailing address
PO BOX 710, 421 E SHORE DR, LAKE VIEW, IA 51450
(712) 657-2211
(712) 657-2106

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
01790
IA
2084P0800X
Psychiatry Physician
01790
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0287888
IA
Enumeration date
03/20/2007
Last updated
09/30/2008
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