Individual
JOHN DAVID LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
75TH MEDICAL GROUP, 7321 BALMER STREET BUILDING 570, HILL AFB, UT 84056
(801) 777-3497
Mailing address
75TH MEDICAL GROUP, 7321 BALMER STREET BUILDING 570, HILL AFB, UT 84056
(801) 777-3497
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4959333-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870430116009
—
UT
Enumeration date
01/07/2009
Last updated
12/03/2024
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