Provider Demographics
NPI:1558560045
Name:LARSON, ELIZABETH GRACE (MS, LMHC, LPC-MHSP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:GRACE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MS, LMHC, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 FRANKLIN RD
Mailing Address - Street 2:STE 215
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4662
Mailing Address - Country:US
Mailing Address - Phone:615-663-8464
Mailing Address - Fax:
Practice Address - Street 1:127 FRANKLIN RD
Practice Address - Street 2:STE 215
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4662
Practice Address - Country:US
Practice Address - Phone:615-663-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6901101YM0800X
TN2645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health