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NPI Code Detail

MEDICARE: ERIC OAKES LARSON LCSW

MEDICARE: ERIC OAKES LARSON 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
11041C0700XClinical Social Worker22317TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
186551QOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1861616724
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC OAKES LARSON LCSW
Provider Business Mailing Address
First Line : 1100 W JACKSON RD
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-1316
Country : US
Telephone Number : 972-242-2182
Fax Number : 972-242-2932
Provider Business Practice Location Address
First Line : 1100 W JACKSON RD
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-1316
Country : US
Telephone Number : 972-242-2182
Fax Number : 972-242-2932
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 07/08/2007

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Directions to “ ERIC OAKES LARSON LCSW” Practice Location

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