Provider Demographics
NPI:1508149766
Name:MUJICA-LARSON, EVELYN PATRICIA (LPC, CRC, CDCI)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:PATRICIA
Last Name:MUJICA-LARSON
Suffix:
Gender:F
Credentials:LPC, CRC, CDCI
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4320 DIPLOMACY DR
Mailing Address - Street 2:SUITE 2191
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5925
Mailing Address - Country:US
Mailing Address - Phone:907-729-5752
Mailing Address - Fax:907-729-4319
Practice Address - Street 1:4320 DIPLOMACY DR
Practice Address - Street 2:SUITE 2191
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:907-729-5752
Practice Address - Fax:907-729-4319
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK589101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional