Individual
MR. MICHAEL E LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
24620 KNOX DR, MARSHALL, MO 65340-4304
(660) 815-2520
(660) 886-6658
Mailing address
PO BOX 75, MARSHALL, MO 65340-0075
(660) 815-2520
(660) 886-6658
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2004035780
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2004035780
STATE LICENSE #
MO
05
—
498373901
—
MO
Enumeration date
06/12/2007
Last updated
02/12/2011
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