Doctor Name: | MRS. SUZANNE M LARSEN |
NPI Number: | 1659762078 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LPC-5615 |
Business Practice Address: | 190 W. Main Street Kuna, ID - 836342022 |
Business Phone Number: | 2089229001 |
Business Fax Number: | |
Mailing Address: | 3856 W Daisy Creek St, MERIDIAN |
State: | ID |
Postal Code: | 836427969 |
Phone Number: | 2089229001 |
Fax Number: | |
NPI Enumeration Date: | 02/06/2015 |
NPI Last Update Date: | 02/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPC-5615 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |