| (talkifuwant.com) | |
|
1701 E Harvest Cir Perryville MO 63775-9330 | |
| (850) 545-2886 | |
| Not Available |
| Full Name | (talkifuwant.com) |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1701 E Harvest Cir, Perryville, Missouri |
| Authorized Official Name and Position | Kurt Dominick Larose (SOLE PROPRIETOR) |
| Authorized Official Contact | 8505452886 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| (talkifuwant.com) 1701 E Harvest Cir Perryville MO 63775-9330 Ph: (850) 545-2886 | (talkifuwant.com) 1701 E Harvest Cir Perryville MO 63775-9330 Ph: (850) 545-2886 |
| NPI Number | 1972914505 |
|---|---|
| Provider Enumeration Date | 05/16/2014 |
| Last Update Date | 02/24/2022 |
| Certification Date | 02/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972914505 | NPI | - | NPPES |
| 12243893 | Other | FL | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW9297 (Florida) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | LC50081569 (District Of Columbia) | Secondary |
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