Provider Demographics
NPI:1275743783
Name:SEVERSON, LARRY J (DPHIL, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:SEVERSON
Suffix:
Gender:M
Credentials:DPHIL, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 C ST
Mailing Address - Street 2:STE., 280
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3916
Mailing Address - Country:US
Mailing Address - Phone:907-562-6418
Mailing Address - Fax:907-563-8287
Practice Address - Street 1:3150 C ST
Practice Address - Street 2:STE., 280
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3916
Practice Address - Country:US
Practice Address - Phone:907-562-6418
Practice Address - Fax:907-563-8287
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK49101YP2500X
AK46106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist