Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1184395170 |
---|---|
Provider Name | Dr. Michael Larson |
First Address | Vancouver, WA 98661-3713 |
Second Address | Vancouver, WA 98661-3713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |