Healthcare Provider Details

I. General information

NPI: 1508229634
Provider Name (Legal Business Name): EMILI LAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1797 340TH AVE
ESTHERVILLE IA
51334-7011
US

IV. Provider business mailing address

1797 340TH AVE
ESTHERVILLE IA
51334-7011
US

V. Phone/Fax

Practice location:
  • Phone: 712-357-8742
  • Fax:
Mailing address:
  • Phone: 712-357-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number081028
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC03849
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: