Provider Demographics
NPI:1376667618
Name:LARSEN, BRETT CHRISTIAN (MA, LPCC-S)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:CHRISTIAN
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MA, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2051
Mailing Address - Country:US
Mailing Address - Phone:513-476-5781
Mailing Address - Fax:513-476-5781
Practice Address - Street 1:3416 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-1717
Practice Address - Country:US
Practice Address - Phone:513-476-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4323101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health