Provider Demographics
NPI:1225217342
Name:LARSON, MARY (LMSW-AP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMSW-AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S JUPITER RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7108
Mailing Address - Country:US
Mailing Address - Phone:972-487-3167
Mailing Address - Fax:972-485-4930
Practice Address - Street 1:600 COLONEL DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2302
Practice Address - Country:US
Practice Address - Phone:972-926-2700
Practice Address - Fax:972-926-2727
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17921171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator