Organization Name: | VASHON LUTHERAN CHURCH |
NPI Number: | 1336205749 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEFFREY J LARSON (PSYCHOLOGIST) |
Mailing Address: | 18623 Vashon Hwy Sw Vashon |
State: | WA US |
Postal Code: | 980705211 |
Phone Number: | 2064636359 |
Fax Number: | |
NPI Enumeration Date: | 12/29/2006 |
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: |