Provider Demographics
NPI:1588036545
Name:LARSON, CHAD WILLIAM (LCSW, CSAC, ICS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:WILLIAM
Last Name:LARSON
Suffix:
Gender:M
Credentials:LCSW, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:ATTENTION WBAMC
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5002
Mailing Address - Country:US
Mailing Address - Phone:915-742-6382
Mailing Address - Fax:915-569-4890
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:027-791-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8300-123101Y00000X, 1041C0700X
WI15603-132101YA0400X
WI15442-134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)