Provider Demographics
NPI:1780847277
Name:LAFORGE'S ADDICTION THERAPY
Entity Type:Organization
Organization Name:LAFORGE'S ADDICTION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFORGE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, AAPS
Authorized Official - Phone:316-312-8823
Mailing Address - Street 1:520 N EMPORIA ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-1624
Mailing Address - Country:US
Mailing Address - Phone:316-312-8823
Mailing Address - Fax:316-452-5647
Practice Address - Street 1:724 OIL HILL RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3360
Practice Address - Country:US
Practice Address - Phone:316-452-5646
Practice Address - Fax:316-452-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS06910870101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty