Provider Demographics
NPI:1952441495
Name:LARKAM, BEVERLEY MCCOSHAM (MSW)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLEY
Middle Name:MCCOSHAM
Last Name:LARKAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 RALEIGH AVENUE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-2128
Mailing Address - Country:US
Mailing Address - Phone:512-476-4182
Mailing Address - Fax:512-476-5648
Practice Address - Street 1:2102 RALEIGH AVENUE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-2128
Practice Address - Country:US
Practice Address - Phone:512-476-4192
Practice Address - Fax:512-476-5648
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXWS0001440Medicaid
TX00S93EMedicare ID - Type Unspecified
TXWS0001440Medicaid