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General NPI Number Information
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NPI Number | 1336967116
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Entity Type | Individual
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Provider Name | CARMEN SHANNON LARSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 02/15/2025
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Provider Practice Location Address
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Address Line | 5900 BALCONES DR # 16280
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 888-458-5199
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Fax |
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Provider Business Mailing Address
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Address Line | 8156 111TH AVE SE
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City | OAKES
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State | ND
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Zip | 58474-9768
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Country | US
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Telephone | 701-412-4656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 109223
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904017959
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License Number State | VA
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