Provider Demographics
NPI:1447860234
Name:LARSON, ERIK (MSW)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-0471
Mailing Address - Country:US
Mailing Address - Phone:208-739-5851
Mailing Address - Fax:
Practice Address - Street 1:305 MAIN ST # 200
Practice Address - Street 2:
Practice Address - City:PALISADE
Practice Address - State:CO
Practice Address - Zip Code:81526-5043
Practice Address - Country:US
Practice Address - Phone:208-739-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health