Provider Demographics
NPI:1568537165
Name:LARSON, VALERIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:J
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8596 E 101ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7037
Mailing Address - Country:US
Mailing Address - Phone:918-982-2610
Mailing Address - Fax:
Practice Address - Street 1:8596 E 101ST ST STE D
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7037
Practice Address - Country:US
Practice Address - Phone:918-982-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9926081041C0700X
OK46721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical