Individual
NATHAN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
(314) 289-6597
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
(314) 289-6597
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
001056
MO
1041C0700X
Clinical Social Worker
SW001056
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
562150
VALUE OPTIONS PROV NUMBER
MO
Enumeration date
01/29/2007
Last updated
01/12/2024
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