Provider Demographics
NPI:1881035723
Name:LARSON, KATHERINE J (MA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 LARIMER ST
Mailing Address - Street 2:SUITE #301A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2050
Mailing Address - Country:US
Mailing Address - Phone:720-306-1744
Mailing Address - Fax:
Practice Address - Street 1:2048 LARIMER ST
Practice Address - Street 2:SUITE #301A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2050
Practice Address - Country:US
Practice Address - Phone:720-306-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0013341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist