Healthcare Provider Details

I. General information

NPI: 1528493301
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL LAUTERBACH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 W MARKET ST #3
LIMA OH
45805-2766
US

IV. Provider business mailing address

PO BOX 355
ANNA OH
45302-0355
US

V. Phone/Fax

Practice location:
  • Phone: 567-376-9235
  • Fax: 419-692-4411
Mailing address:
  • Phone: 502-220-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC1300220
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: