Provider Demographics
NPI:1609410422
Name:MISTICH, LAINY (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:LAINY
Middle Name:
Last Name:MISTICH
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-4706
Mailing Address - Country:US
Mailing Address - Phone:504-912-0197
Mailing Address - Fax:
Practice Address - Street 1:206 BARBERRY CT
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-4706
Practice Address - Country:US
Practice Address - Phone:504-912-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7714101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor