Provider Demographics
NPI:1710464391
Name:LARSEN, SARAH (BS PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:BS PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2911
Mailing Address - Country:US
Mailing Address - Phone:971-276-2060
Mailing Address - Fax:
Practice Address - Street 1:201 S HIGH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2911
Practice Address - Country:US
Practice Address - Phone:971-276-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-31
Deactivation Date:2018-07-25
Deactivation Code:
Reactivation Date:2018-07-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician