Provider Demographics
NPI:1205378908
Name:LARSON, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:LARSON
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 1:225 BUCCANEER AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2537
Mailing Address - Country:US
Mailing Address - Phone:321-300-3563
Mailing Address - Fax:
Practice Address - Street 1:225 BUCCANEER AVE APT 204
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-2537
Practice Address - Country:US
Practice Address - Phone:321-300-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst