Provider Demographics
NPI:1811157423
Name:LARKS, LORI J (MFT)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:J
Last Name:LARKS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:LORETTA
Other - Middle Name:JEAN
Other - Last Name:LARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:40 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4068
Mailing Address - Country:US
Mailing Address - Phone:925-313-1744
Mailing Address - Fax:925-313-1639
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-270-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 30415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist