Individual
CRYSTAL ANN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6348 W EMERALD ST, BOISE, ID 83704-8732
(208) 302-0900
(208) 302-0955
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642
(208) 302-0900
(208) 302-0955
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
7704
KS
2084P0800X
Psychiatry Physician
DO170871
OR
2084P0800X
Psychiatry Physician
Primary
O-1357
ID
Other
Enumeration date
06/23/2011
Last updated
05/14/2021
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