Nicole Larsen, M.MFT,LMFT-ASSOCIATE

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

204730 Issued in TX

Practice address

17920 Huffmeister Rd Ste 150
Cypress, TX 77429-6445

Phone

(832) 421-8714

NPI assigned

Sep 12, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nikki Larsen Other name

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Marriage and Family Therapist

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desta Therapy, LLCGroup PAC ID 8224566708, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Desta Therapy, LLC

  • Mental Health Counselor
  • San Antonio, TX
  • NPI 1891529673
  Medicare reassignment Care Compare group NPD
• Amy Wine Counseling Center, Inc.

  • Counselor
  • Cypress, TX
  • NPI 1801321054
  NPD (past)

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1639891161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16411 FALCONS COVE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770955435",
            "telephone_number": "281-513-5650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17920 HUFFMEISTER RD STE 150",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774296445",
            "telephone_number": "832-421-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "NICOLE",
        "credential": "M.MFT,LMFT-ASSOCIATE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "204730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL",
            "identifier": "204730",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NIKKI",
            "last_name": "LARSEN",
            "credential": "M.MFT,LMFT-ASSOCIATE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ashlyn Neal Landry, PTA
• Lashawndria Landry, NP-C
• Scott Lange
• Faith Ann Lanthier, BS
• Lark Home Care, LLC
• Julia Larson
• Renee Lasprilla Tarazona, LCSW
• Kevin Lassen
• Lassetter Home Care
• Melissa Jean Lassetter, R.N.

• Marriage & Family Therapist in Cypress, TX
• Providers in Cypress, TX by specialty
• Marriage & Family Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.