Provider Demographics
NPI:1235900168
Name:LARSON, SHELIA LENETT
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:LENETT
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 1:222 FRONT ST STE 104
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1228
Mailing Address - Country:US
Mailing Address - Phone:907-463-0600
Mailing Address - Fax:907-463-0601
Practice Address - Street 1:222 FRONT ST STE 104
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1228
Practice Address - Country:US
Practice Address - Phone:907-463-0600
Practice Address - Fax:907-463-0601
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty