Provider Demographics
NPI:1205154267
Name:LARSON, VICTORIA L (MA)
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:L
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 1:6804 E 2ND ST APT 28
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5349
Mailing Address - Country:US
Mailing Address - Phone:503-888-2066
Mailing Address - Fax:
Practice Address - Street 1:2400 W DUNLAP AVE STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2822
Practice Address - Country:US
Practice Address - Phone:602-943-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist