Provider Demographics
NPI:1013408269
Name:LARKS, CAMERON LENORE
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:LENORE
Last Name:LARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8155 JEFFERSON HWY APT 104
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1607
Mailing Address - Country:US
Mailing Address - Phone:225-402-1834
Mailing Address - Fax:
Practice Address - Street 1:230 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4725
Practice Address - Country:US
Practice Address - Phone:225-349-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician