Individual
LAURA LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17503 W PERSHING ST, SURPRISE, AZ 85388-5021
(623) 537-5119
Mailing address
17503 W PERSHING ST, SURPRISE, AZ 85388-5021
(623) 537-5119
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11958
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11958
PROF FOSTER PARENT
AZ
01
—
171878
AHCCS
AZ
Enumeration date
01/31/2007
Last updated
06/20/2013
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