Provider Demographics
NPI:1740573765
Name:LARSON, KRISTINA N
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:N
Last Name:LARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 E PAGES LN
Mailing Address - Street 2:A
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2216
Mailing Address - Country:US
Mailing Address - Phone:801-294-0578
Mailing Address - Fax:801-298-2147
Practice Address - Street 1:94 E PAGES LN
Practice Address - Street 2:A
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2216
Practice Address - Country:US
Practice Address - Phone:801-294-0578
Practice Address - Fax:801-298-2147
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional