| Doctor Name: | JEFFREY J LARSON |
| NPI Number: | 1326179177 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 3718 |
| Business Practice Address: | 18623 Vashon Hwy Sw Vashon, WA - 980705211 |
| Business Phone Number: | 2064636359 |
| Business Fax Number: | |
| Mailing Address: | 11628 103rd Ave Sw, VASHON |
| State: | WA |
| Postal Code: | 980703106 |
| Phone Number: | 2064636359 |
| Fax Number: | |
| NPI Enumeration Date: | 03/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP1600X |
| License Number: | 3718 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Pastoral |
| Taxonomy Definition: | |