Individual
TRACY LARSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1919 N AMIDON AVE, STE. 100, WICHITA, KS 67203-2117
(316) 660-7540
(316) 660-7588
Mailing address
635 N MAIN ST, WICHITA, KS 67203-3602
(316) 660-7600
(316) 383-7925
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
5726
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200919
BLUE CROSS BLUE SHIELD
KS
01
—
8680
PREFERRED HEALTH SYSTEMS
KS
Enumeration date
05/19/2006
Last updated
07/08/2007
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