Provider Demographics
NPI:1275287773
Name:LAURA KINNEY LLC
Entity Type:Organization
Organization Name:LAURA KINNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:402-880-1683
Mailing Address - Street 1:136 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-9037
Mailing Address - Country:US
Mailing Address - Phone:712-458-6201
Mailing Address - Fax:402-702-2547
Practice Address - Street 1:136 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9037
Practice Address - Country:US
Practice Address - Phone:712-458-6201
Practice Address - Fax:402-702-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty