Provider Demographics
NPI:1972914505
Name:KURT LAROSE MSW LCSW
Entity Type:Organization
Organization Name:KURT LAROSE MSW LCSW
Other - Org Name:(TALKIFUWANT.COM)
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:DOMINICK
Authorized Official - Last Name:LAROSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LICSW
Authorized Official - Phone:850-545-2886
Mailing Address - Street 1:1701 E HARVEST CIR
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-9330
Mailing Address - Country:US
Mailing Address - Phone:850-545-2886
Mailing Address - Fax:
Practice Address - Street 1:1701 E HARVEST CIR
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-9330
Practice Address - Country:US
Practice Address - Phone:850-545-2886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92971041C0700X
DCLC50081569261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12243893OtherCAQH
FLZ176VOtherBLUE CROSS BLUE SHIELD
FLCR252AOtherMEDICARE
FL9041674OtherAETNA
FLZ176VOtherBLUE CROSS BLUE SHIELD