Individual
TARA LEE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
509 W 10TH ST, ANTIOCH, CA 94509-1653
(925) 777-9540
Mailing address
509 W 10TH ST, ANTIOCH, CA 94509-1653
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
CA
Other
Enumeration date
01/10/2008
Last updated
01/10/2008
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