Provider Demographics
NPI:1447928841
Name:LARSON, JULIE (LCSW, LISW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4323
Mailing Address - Country:US
Mailing Address - Phone:917-309-6145
Mailing Address - Fax:
Practice Address - Street 1:2404 FOREST DR STE 250
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5400
Practice Address - Country:US
Practice Address - Phone:917-309-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA849701041C0700X
NY730769011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical