Provider Demographics
NPI:1891167862
Name:TANYA LARSON THERAPY
Entity Type:Organization
Organization Name:TANYA LARSON THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA,MHP,LMHCA
Authorized Official - Phone:253-686-9421
Mailing Address - Street 1:1102 A. ST., SUITE 109
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402
Mailing Address - Country:US
Mailing Address - Phone:253-686-9421
Mailing Address - Fax:
Practice Address - Street 1:1102 A. ST., SUITE 109
Practice Address - Street 2:(SUITE 109)
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-686-9421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60489337251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health