Individual
PHYLLIS LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1432 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109
(573) 632-5560
(573) 632-5875
Mailing address
1432 SOUTHWEST BLVD, CAPITAL REGION PSYCHOLOGY & COUNSELING, JEFFERSON CITY, MO 65109
(573) 632-5560
(573) 632-5875
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
434
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166304
BCBS
MO
05
—
493531677
—
MO
Enumeration date
05/31/2006
Last updated
07/01/2009
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