Provider Demographics
NPI:1407393150
Name:LARSON, MEGAN ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ROSE
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:ROSE
Other - Last Name:SALYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2780 NEW HOLT RD STE D
Mailing Address - Street 2:# 373
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7441
Mailing Address - Country:US
Mailing Address - Phone:971-334-1940
Mailing Address - Fax:
Practice Address - Street 1:555 JEFFERSON ST STE 301
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-1088
Practice Address - Country:US
Practice Address - Phone:971-334-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL107911041C0700X
ORA4695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical