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General NPI Number Information
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NPI Number | 1780847277
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Entity Type | Organization
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Legal Business Name | LAFORGE'S ADDICTION THERAPY
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 724 OIL HILL RD
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City | EL DORADO
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State | KS
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Zip | 67042-3360
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Country | US
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Telephone | 316-452-5646
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Fax | 316-452-5647
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Provider Business Mailing Address
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Address Line | 520 N EMPORIA ST
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City | EL DORADO
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State | KS
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Zip | 67042-1624
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Country | US
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Telephone | 316-312-8823
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Fax | 316-452-5647
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. KARYN LAFORGE
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Credential | BS, AAPS
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Telephone | 316-312-8823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 06910870
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License Number State | KS
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