Provider Demographics
NPI:1356733604
Name:LARSEN, ANDREA CAMILLE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAMILLE
Last Name:LARSEN
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 1:4778 S ZENO ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3250
Mailing Address - Country:US
Mailing Address - Phone:303-351-1255
Mailing Address - Fax:
Practice Address - Street 1:8340 SANGRE DE CRISTO ROAD., SUITE 212
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80217-3250
Practice Address - Country:US
Practice Address - Phone:303-351-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0106142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health