Individual
DANETTE LEE LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMHC
Contact information
Practice address
613 E FORT UNION BLVD STE 104, MIDVALE, UT 84047-5531
(801) 984-1717
(801) 984-1720
Mailing address
613 E FORT UNION BLVD STE 104, MIDVALE, UT 84047-5531
(801) 984-1717
(801) 984-1720
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6823638-6004
UT
Other
Enumeration date
04/10/2019
Last updated
06/11/2019
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