Provider Demographics
NPI:1447961677
Name:LARKS, ALEXANDRA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ANNE
Last Name:LARKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 HILLCREST RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-7121
Mailing Address - Country:US
Mailing Address - Phone:469-251-4646
Mailing Address - Fax:
Practice Address - Street 1:12720 HILLCREST RD STE 106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-7121
Practice Address - Country:US
Practice Address - Phone:469-251-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39143103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling