Individual
LISA K LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
265 E CHUBBUCK RD, CHUBBUCK, ID 83202-5055
(208) 237-1711
(208) 237-9806
Mailing address
265 E CHUBBUCK RD, CHUBBUCK, ID 83202-5055
(208) 237-1711
(208) 237-9806
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LMSW-44463
ID
Other
Enumeration date
05/16/2024
Last updated
05/16/2024
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