Healthcare Provider Details

I. General information

NPI: 1174492334
Provider Name (Legal Business Name): KHEILBI LAROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 MEADE HILL RD
MORGAN VT
05853-9687
US

IV. Provider business mailing address

30 AIRPORT RD
SOUTH BURLINGTON VT
05403-6432
US

V. Phone/Fax

Practice location:
  • Phone: 802-648-8070
  • Fax:
Mailing address:
  • Phone: 802-648-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0137464
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: