Organization
MATTHEW G LARSON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW G LARSON LCSW (OWNER)
(801) 521-0699
Entity
Organization
Contact information
Practice address
24 S 600 E STE 6, SALT LAKE CITY, UT 84102-4201
(801) 521-0699
(801) 521-0688
Mailing address
PO BOX 1221, SALT LAKE CITY, UT 84101-4201
(801) 521-0699
(801) 521-0688
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
03609393501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528330442001
—
UT
Enumeration date
02/25/2008
Last updated
02/25/2008
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