Provider Demographics
NPI:1417598673
Name:JULIA LARSEN PLCC, CORPORATION
Entity Type:Organization
Organization Name:JULIA LARSEN PLCC, CORPORATION
Other - Org Name:PANDORA'S HOUSE MENTAL HEALTH PROVIDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:972-784-3064
Mailing Address - Street 1:6011 CRESTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-6501
Mailing Address - Country:US
Mailing Address - Phone:903-454-3300
Mailing Address - Fax:903-454-3307
Practice Address - Street 1:107 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2213
Practice Address - Country:US
Practice Address - Phone:972-784-3064
Practice Address - Fax:972-784-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141598673OtherORGANIZATIONAL NPI
TX3866873Medicaid