MEDICARE: ANNA LAROUCHE LCSW

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	1041C0700X	Clinical Social Worker	7181	TN

General Provider Information

NPI Number	:	1518560697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA LAROUCHE LCSW

Provider Business Mailing Address
First Line	:	3628 SUMMER AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3628 SUMMER AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3740
Country	:	US
Telephone Number	:	901-452-6941
Fax Number	:

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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