Provider Demographics
NPI:1780206367
Name:LARSON, LINDA IRENE (PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:IRENE
Last Name:LARSON
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:IRENE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:217 CEDAR ST # 177
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1410
Mailing Address - Country:US
Mailing Address - Phone:208-255-9227
Mailing Address - Fax:
Practice Address - Street 1:217 EUCLID
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-255-6057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLAMFT-7618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMFT-7618OtherPH.D.
LAMFT-7618OtherLICENSED MARRIAGE AND FAMILY THERAPIST