Provider Demographics
NPI:1881603504
Name:LARSEN, MICHELE HOOPER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:HOOPER
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 WOODLAND GLADE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-5115
Mailing Address - Country:US
Mailing Address - Phone:281-222-7721
Mailing Address - Fax:281-890-5564
Practice Address - Street 1:10605 GRANT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4452
Practice Address - Country:US
Practice Address - Phone:281-222-7721
Practice Address - Fax:281-890-5564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750663Medicaid
TX611926Medicare ID - Type Unspecified