Basic Information
| Provider Information | |||||||||
| NPI: | 1114050259 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOTTIN | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | FRED | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13008 W 102ND TERRACE | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 62215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133070155 | ||||||||
| FaxNumber: | 8169223317 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 LINWOOD BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168614700 | ||||||||
| FaxNumber: | 8169223317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2007000615 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.