Provider Demographics
NPI:1861862021
Name:LARSEN, KASSANDRA DIANE (LPCC, NCC, MA)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:DIANE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LPCC, NCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 W 10TH AVENUE PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1015
Mailing Address - Country:US
Mailing Address - Phone:720-266-4444
Mailing Address - Fax:
Practice Address - Street 1:1255 LEE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4542
Practice Address - Country:US
Practice Address - Phone:720-266-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0014200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional