Provider Demographics
NPI:1871282434
Name:LASTOVICA, HAYLEY LAYNE (LPC)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:LAYNE
Last Name:LASTOVICA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 KINSHIP PKWY APT 2307
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-2259
Mailing Address - Country:US
Mailing Address - Phone:832-696-3960
Mailing Address - Fax:
Practice Address - Street 1:1772 W MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3342
Practice Address - Country:US
Practice Address - Phone:469-340-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty