Provider Demographics
NPI:1336133578
Name:JOHN LARGEN AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:JOHN LARGEN AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LARGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-799-2818
Mailing Address - Street 1:1020 HOLCOMBE BLVD
Mailing Address - Street 2:STE 1304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2210
Mailing Address - Country:US
Mailing Address - Phone:713-799-2818
Mailing Address - Fax:713-790-1454
Practice Address - Street 1:1020 HOLCOMBE BLVD
Practice Address - Street 2:STE 1304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2210
Practice Address - Country:US
Practice Address - Phone:713-799-2818
Practice Address - Fax:713-790-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029HQOtherBCBS
TX00602RMedicare ID - Type Unspecified