Provider Demographics
NPI:1134392012
Name:LARSEN, BETH ANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12840 TIMBERLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8334
Mailing Address - Country:US
Mailing Address - Phone:616-846-6124
Mailing Address - Fax:616-846-6124
Practice Address - Street 1:675 E 16TH ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3786
Practice Address - Country:US
Practice Address - Phone:616-405-6288
Practice Address - Fax:616-846-6124
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010878191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical