Provider Demographics
NPI:1689726325
Name:PROBASCO, LAURA KRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KRISTINA
Last Name:PROBASCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 W KANSAS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2281
Mailing Address - Country:US
Mailing Address - Phone:816-781-8550
Mailing Address - Fax:816-792-3219
Practice Address - Street 1:1135 W KANSAS ST
Practice Address - Street 2:SUITE B
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2281
Practice Address - Country:US
Practice Address - Phone:816-781-8550
Practice Address - Fax:816-792-3219
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060382651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical