Individual
LARNESSA DALLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPRP, MHP,AAS
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
47-1223781
MD
171M00000X
Case Manager/Care Coordinator
47-1223781
MD
225400000X
Rehabilitation Practitioner
Primary
47-1223781
MD
225C00000X
Rehabilitation Counselor
47-1223781
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47-1223781
IRS
MD
Enumeration date
09/02/2016
Last updated
09/02/2016
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