Provider Demographics
NPI:1023621448
Name:LARIOS, CARLOS ALFREDO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALFREDO
Last Name:LARIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N BERRIEN ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2102
Practice Address - Country:US
Practice Address - Phone:517-998-4673
Practice Address - Fax:517-998-0005
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-11-20
Deactivation Date:2020-09-23
Deactivation Code:
Reactivation Date:2020-11-20
Provider Licenses
StateLicense IDTaxonomies
MI6401018549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health