Provider Demographics
NPI:1700431780
Name:LARSEN, BRITTANY KRISTINE (MA)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:KRISTINE
Last Name:LARSEN
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 1:1737 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3023
Mailing Address - Country:US
Mailing Address - Phone:773-653-6880
Mailing Address - Fax:
Practice Address - Street 1:4050 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3067
Practice Address - Country:US
Practice Address - Phone:312-401-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health