Provider Demographics
NPI:1245523497
Name:LARSEN, NIAZ (LPC)
Entity type:Individual
Prefix:MRS
First Name:NIAZ
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3461
Mailing Address - Country:US
Mailing Address - Phone:503-804-1467
Mailing Address - Fax:
Practice Address - Street 1:25030 SW PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-597-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health