Provider Demographics
NPI:1689603664
Name:LARI A AYCOCK
Entity Type:Organization
Organization Name:LARI A AYCOCK
Other - Org Name:HEART CHOICES CARE MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LARI
Authorized Official - Middle Name:
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:830-739-3608
Mailing Address - Street 1:800 LAZY LN
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2824
Mailing Address - Country:US
Mailing Address - Phone:830-739-3608
Mailing Address - Fax:830-895-2867
Practice Address - Street 1:800 LAZY LN
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2824
Practice Address - Country:US
Practice Address - Phone:830-739-3608
Practice Address - Fax:830-895-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00926YMedicare ID - Type Unspecified