Individual
ELIZABETH T LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2176 E FRANKLIN RD, MERIDIAN, ID 83642-9024
(208) 830-4036
Mailing address
5621 LYNWOOD PL, BOISE, ID 83706-1035
(208) 323-1473
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC397
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000 101 48195
REGENCE
ID
01
—
Q4319
BLUE CROSS
ID
Enumeration date
03/19/2008
Last updated
03/19/2008
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