Provider Demographics
NPI:1023684552
Name:KIM LAGRO COUNSELING SERVICES,LLC
Entity type:Organization
Organization Name:KIM LAGRO COUNSELING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LAGRO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW/ LCSW
Authorized Official - Phone:715-256-8907
Mailing Address - Street 1:4099 E LEGGATE RD
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-8347
Mailing Address - Country:US
Mailing Address - Phone:715-817-0209
Mailing Address - Fax:
Practice Address - Street 1:2207 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3780
Practice Address - Country:US
Practice Address - Phone:715-256-8907
Practice Address - Fax:715-256-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty