Provider Demographics
NPI:1053063131
Name:LARSEN, KAREY (LAC)
Entity Type:Individual
Prefix:
First Name:KAREY
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 E VIA DE VENTURA APT B278
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3143
Mailing Address - Country:US
Mailing Address - Phone:702-672-6182
Mailing Address - Fax:
Practice Address - Street 1:8149 N 87TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4399
Practice Address - Country:US
Practice Address - Phone:424-653-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC7175-T101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor