MEDICARE: JADE KAY-MARIE LARSON-HOUCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	1630	NV
2	1041C0700X	Clinical Social Worker	10297-C	NV

General Provider Information

NPI Number	:	1366961971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE KAY-MARIE LARSON-HOUCK

Provider Business Mailing Address
First Line	:	4045 SPENCER ST STE A48
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5245
Country	:	US
Telephone Number	:	702-483-0190
Fax Number	:

Provider Business Practice Location Address
First Line	:	4045 SPENCER ST STE A48
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5245
Country	:	US
Telephone Number	:	702-483-0190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2017
Last Update Date	:	10/05/2022

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