Provider Demographics
NPI:1033522511
Name:LARSEN, BRANDY KAY
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:KAY
Last Name:LARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1000
Mailing Address - Country:US
Mailing Address - Phone:661-868-2694
Mailing Address - Fax:661-327-8768
Practice Address - Street 1:1415 TRUXTUN AVE FL 4
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5215
Practice Address - Country:US
Practice Address - Phone:661-868-4616
Practice Address - Fax:661-327-8768
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049090218101YA0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program