Individual provider Active NPI

Molly G Larson, LPC

  • Professional Counselor
  • Lake Charles, LA
National Provider Identifier
1336100932
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
2394 Issued in LA
Practice address
2829 4TH Ave Ste 150
Lake Charles, LA 70601-7897
Phone
(337) 480-7800
Fax
(337) 474-4552
NPI assigned
Mar 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 71 LA
Professional Counselor 101YP2500X 2394 LA Primary

Addresses

Primary practice location

2829 4TH Ave Ste 150
Lake Charles, LA 70601-7897

Mailing address

PO Box 123977 Dept 3977
Dallas, TX 75312-3977
Phone (337) 494-2921

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240102001224 LA Practitioner - Marriage and Family Therapist 8224488358 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MMG Archer Institute, LLCGroup PAC ID 7719227115, 16 clinicians

Practice addresses (Care Compare)

2615 Enterprise Blvd
Suite a
Lake Charles, LA 70601-7686
Phone (337) 480-7800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71LAMDMarriage & Family Therapist
2394LAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
MMG Archer Institute, LLC CurrentSince Jan 1, 2024 Accepting new patients
Southwest Louisiana Hospital Association Inc CurrentSince May 16, 2022 Accepting new patients

Locations

2615 Enterprise Blvd
Ste A
Lake Charles, LA 70601
Phone (337) 480-7800

2829 4th Ave
Ste 150
Lake Charles, LA 70601
Phone (337) 477-7091

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1336100932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123977 DEPT 3977",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753123977",
            "telephone_number": "337-494-2921",
            "fax_number": "373-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 4TH AVE STE 150",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017897",
            "telephone_number": "337-480-7800",
            "fax_number": "337-474-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "MOLLY",
        "middle_name": "G",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-31",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "LA",
            "license": "71",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "2394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.