Provider Demographics
NPI:1184050957
Name:LARSON, CELINA ULULANI
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:ULULANI
Last Name:LARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0905
Mailing Address - Country:US
Mailing Address - Phone:208-304-8918
Mailing Address - Fax:208-625-2064
Practice Address - Street 1:1009 HIGHWAY 2 STE E
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2736
Practice Address - Country:US
Practice Address - Phone:208-304-8918
Practice Address - Fax:208-625-2064
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-330531041C0700X
WALW610514161041C0700X
IDLCSW-354251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical