Provider Demographics
NPI:1639891161
Name:LARSEN, NICOLE (MMFT,LMFT-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MMFT,LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MMFT,LMFT-ASSOCIATE
Mailing Address - Street 1:16411 FALCONS COVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5435
Mailing Address - Country:US
Mailing Address - Phone:281-513-5650
Mailing Address - Fax:
Practice Address - Street 1:17920 HUFFMEISTER RD STE 150
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-6445
Practice Address - Country:US
Practice Address - Phone:832-421-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204730OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL