Laurie Lee Black | Farmington, MO • PECOS Search

Laurie Lee Black

Social Worker

Behavioral Health & Social Service Providers

591 Kimberly Ct, Farmington, MO 63640-2032

PECOS Enrollment

Based on the most recent information from CMS, provider Laurie Lee Black does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:13 AM.

Profile Details

Provider ID
1174829881
Provider Type
Individual
Full Name
Black, Laurie Lee
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
1/28/2011
Last Updated
1/28/2011

Contact Information

Practice Location

591 Kimberly Ct, Farmington, MO 63640-2032

Unlisted Fax

Mailing Location

591 Kimberly Ct, Farmington, MO 63640-2032

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 2010030680 Missouri