Provider Demographics
NPI:1346540325
Name:LARSEN, ANTHONY LYNN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:LYNN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:L
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:2635 W DESCHUTES AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3004
Mailing Address - Country:US
Mailing Address - Phone:509-783-0500
Mailing Address - Fax:509-783-9129
Practice Address - Street 1:2635 W DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3004
Practice Address - Country:US
Practice Address - Phone:509-783-0500
Practice Address - Fax:509-783-9129
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00004969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health