Provider Demographics
NPI:1710385174
Name:LARSON, LOGAN (LPC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2701
Mailing Address - Country:US
Mailing Address - Phone:907-229-5029
Mailing Address - Fax:877-992-7056
Practice Address - Street 1:307 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2701
Practice Address - Country:US
Practice Address - Phone:907-229-5029
Practice Address - Fax:877-992-7056
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional