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General NPI Number Information
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NPI Number | 1346882099
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Entity Type | Organization
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Legal Business Name | LK THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 10/15/2019
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Provider Practice Location Address
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Address Line | 4250 66TH ST N
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City | KENNETH CITY
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State | FL
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Zip | 33709-4918
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Country | US
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Telephone | 727-546-2405
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Fax |
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Provider Business Mailing Address
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Address Line | 9994 83RD ST
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City | LARGO
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State | FL
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Zip | 33777-1910
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Country | US
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Telephone | 727-278-2949
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEONARD KLASKOW
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Credential | LCSW
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Telephone | 727-278-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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