Individual
JUSTIN LARS LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CDCA, CPRS
Contact information
Practice address
412 OHIO AVE, GIRARD, OH 44420-3244
(330) 314-6647
Mailing address
412 OHIO AVE, GIRARD, OH 44420-3244
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
00566
OH
Other
Enumeration date
12/27/2018
Last updated
12/27/2018
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