Provider Demographics
NPI:1548407026
Name:LARSON, VALERIE ANN (BGS, BCABA)
Entity Type:Individual
Prefix:MISS
First Name:VALERIE
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:BGS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1120 ENCINITAS PT
Mailing Address - Street 2:APT 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-9109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 ELKTON DR
Practice Address - Street 2:SUITE 403
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8507
Practice Address - Country:US
Practice Address - Phone:719-494-9067
Practice Address - Fax:719-570-0386
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-08-2635103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst