Provider Demographics
NPI:1336967116
Name:LARSON, CARMEN SHANNON (LMSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:SHANNON
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:ALBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8156 111TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-9768
Mailing Address - Country:US
Mailing Address - Phone:701-412-4656
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR # 16280
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4257
Practice Address - Country:US
Practice Address - Phone:888-458-5199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092231041C0700X
VA09040179591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical