Provider Demographics
NPI:1386977585
Name:FASO, LAURA E (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:FASO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S NEOSHO BLVD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1646
Mailing Address - Country:US
Mailing Address - Phone:417-592-9415
Mailing Address - Fax:
Practice Address - Street 1:214 S NEOSHO BLVD
Practice Address - Street 2:SUITE C-1
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1646
Practice Address - Country:US
Practice Address - Phone:417-592-9415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW005431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical