Healthcare Provider Details

I. General information

NPI: 1841678620
Provider Name (Legal Business Name): LAARC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 15TH AVE
LONGMONT CO
80501-2715
US

IV. Provider business mailing address

905 15TH AVE
LONGMONT CO
80501-2715
US

V. Phone/Fax

Practice location:
  • Phone: 360-903-8547
  • Fax:
Mailing address:
  • Phone: 360-903-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3941
License Number StateCO

VIII. Authorized Official

Name: DR. KATHRINE MARIE HAK
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 360-903-8547