Provider Demographics
NPI:1588041388
Name:LARSEN SANCHEZ PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:LARSEN SANCHEZ PSYCHOLOGY, LLC
Other - Org Name:PORTLAND MENTAL HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-715-5468
Mailing Address - Street 1:905 SE 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2569
Mailing Address - Country:US
Mailing Address - Phone:503-715-5468
Mailing Address - Fax:503-715-5469
Practice Address - Street 1:905 SE 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2569
Practice Address - Country:US
Practice Address - Phone:503-622-8964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty