Individual
DIANE AVERILL LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.C., M.F..T
Contact information
Practice address
2101 E BROADWAY RD STE 4, TEMPE, AZ 85282-1735
(602) 695-7549
Mailing address
2101 E BROADWAY RD STE 4, TEMPE, AZ 85282-1735
(602) 695-7549
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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