Provider Demographics
NPI:1861616724
Name:LARSON, ERIC OAKES (LCSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:OAKES
Last Name:LARSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1316
Mailing Address - Country:US
Mailing Address - Phone:972-242-2182
Mailing Address - Fax:972-242-2932
Practice Address - Street 1:1100 W JACKSON RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1316
Practice Address - Country:US
Practice Address - Phone:972-242-2182
Practice Address - Fax:972-242-2932
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86551QOtherBLUE CROSS BLUE SHIELD