Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 3718 | WA |
N | 103G00000X | Clinical Psychologist | 1608 | WA |
N | 103TC0700X | Clinical Psychologist | 1608 | WA |
NPI | 1326179177 |
---|---|
Provider Name | Jeffrey J Larson |
First Address | Vashon, WA 98070-3106 |
Second Address | Vashon, WA 98070-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |