Healthcare Provider Details

I. General information

NPI: 1134626971
Provider Name (Legal Business Name): AMY MARIE RAUCH LABOUNTY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. AMY MARIE RAUCH-LABOUNTY

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LETOURNEAU CIRCLE EMBEDDED
HURLBURT FIELD FL
32544
US

IV. Provider business mailing address

130 LETOURNEAU CIRCLE BUILDING 91020
APO AA
32544
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-4237
  • Fax:
Mailing address:
  • Phone: 850-881-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC012780
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: