Provider Demographics
NPI:1710919048
Name:AYCOCK, LARI (LCSW)
Entity Type:Individual
Prefix:
First Name:LARI
Middle Name:
Last Name:AYCOCK
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 1:800 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 1:135 PLAZA DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2230
Practice Address - Country:US
Practice Address - Phone:830-739-3608
Practice Address - Fax:830-895-2867
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0248Medicare ID - Type Unspecified