Provider Demographics
NPI:1992850085
Name:LARSON, MEGAN SUSANNE (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:SUSANNE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 MIDDLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4426
Mailing Address - Country:US
Mailing Address - Phone:812-378-4428
Mailing Address - Fax:812-378-4427
Practice Address - Street 1:3220 MIDDLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-4426
Practice Address - Country:US
Practice Address - Phone:812-378-4428
Practice Address - Fax:812-378-4427
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004808A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN076965OtherSIHO
IN000000381518OtherANTHEM