Provider Demographics
NPI:1013924471
Name:LARGENT, ANN (LPCC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LARGENT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 QUAY ROAD A
Mailing Address - Street 2:P.O. BOX 178
Mailing Address - City:SAN JON
Mailing Address - State:NM
Mailing Address - Zip Code:88434-9639
Mailing Address - Country:US
Mailing Address - Phone:505-576-1234
Mailing Address - Fax:505-461-0404
Practice Address - Street 1:102 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2726
Practice Address - Country:US
Practice Address - Phone:505-461-6200
Practice Address - Fax:505-461-0404
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0088741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional