MEDICARE: TANEISHA AUDIE-ANN LAUTURE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	171M00000X	Case Manager/Care Coordinator
3	101Y00000X	Counselor

General Provider Information

NPI Number	:	1861374035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANEISHA AUDIE-ANN LAUTURE

Provider Business Mailing Address
First Line	:	191 LIBERTY CORNERS RD
Second Line	:
City	:	PINE ISLAND
State	:	NY
Zip	:	10969-1618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 LIBERTY CORNERS RD
Second Line	:
City	:	PINE ISLAND
State	:	NY
Zip	:	10969-1618
Country	:	US
Telephone Number	:	240-374-3104
Fax Number	:

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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