MEDICARE: LYN HASSENBOEHLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3340	LA

General Provider Information

NPI Number	:	1356768121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYN HASSENBOEHLER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 959
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-0959
Country	:	US
Telephone Number	:	225-456-0093
Fax Number	:	888-494-0963

Provider Business Practice Location Address
First Line	:	37292 MARKET PLACE DR STE C
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-3487
Country	:	US
Telephone Number	:	225-456-0093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	03/04/2022

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