Provider Demographics
NPI:1780228007
Name:LARSSON, ADELE ANN (PHD)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:ANN
Last Name:LARSSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 N UNION BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4075
Mailing Address - Country:US
Mailing Address - Phone:719-323-3094
Mailing Address - Fax:719-266-1773
Practice Address - Street 1:7730 N UNION BLVD STE 105
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4075
Practice Address - Country:US
Practice Address - Phone:719-323-3094
Practice Address - Fax:719-266-1773
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005176103T00000X
WAPY61114401103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist