Provider Demographics
NPI:1609909985
Name:LARSON, BRENDA KAYE (MA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAYE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:KAYE
Other - Last Name:WELDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 DAVID DEAN WAY
Mailing Address - Street 2:
Mailing Address - City:KALAMA
Mailing Address - State:WA
Mailing Address - Zip Code:98625
Mailing Address - Country:US
Mailing Address - Phone:360-673-1799
Mailing Address - Fax:
Practice Address - Street 1:921 14TH AVE
Practice Address - Street 2:LOWER COLUMBIA MENTAL HEALTH CTR
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-423-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health