Provider Demographics
NPI:1164796421
Name:LARSEN, WHITNEY BLAIR (LMFT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:BLAIR
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 W 25 N
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-9211
Mailing Address - Country:US
Mailing Address - Phone:435-237-5060
Mailing Address - Fax:
Practice Address - Street 1:347 N 300 W STE 201A
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1828
Practice Address - Country:US
Practice Address - Phone:385-231-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8087899-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist