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Individual
BRETT KEVIN LARSEN
Active
Individual
BRETT KEVIN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
NULL
1041C0700X
Clinical Social Worker
Primary
10516521-3501
UT
1041C0700X
Clinical Social Worker
76799
CA
Other
Enumeration date
09/13/2013
Last updated
05/16/2022
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