Provider Demographics
NPI:1619079258
Name:LARSEN, BETH ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E. HIGHLAND MALL BOULEVARD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:512-923-2384
Mailing Address - Fax:512-628-6908
Practice Address - Street 1:314 E. HIGHLAND MALL BOULEVARD
Practice Address - Street 2:SUITE 401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752
Practice Address - Country:US
Practice Address - Phone:512-923-2384
Practice Address - Fax:512-628-6908
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142161041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical