Healthcare Provider Details

I. General information

NPI: 1346882099
Provider Name (Legal Business Name): LK THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 66TH ST N
KENNETH CITY FL
33709-4918
US

IV. Provider business mailing address

9994 83RD ST
LARGO FL
33777-1910
US

V. Phone/Fax

Practice location:
  • Phone: 727-546-2405
  • Fax:
Mailing address:
  • Phone: 727-278-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LEONARD KLASKOW
Title or Position: PRESIDENT
Credential: LCSW
Phone: 727-278-2949