Provider Demographics
NPI:1720264690
Name:LARSEN, A. BROOKS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:A.
Middle Name:BROOKS
Last Name:LARSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:ASHBY
Other - Middle Name:BROOKS
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84643-0209
Mailing Address - Country:US
Mailing Address - Phone:092-669-2880
Mailing Address - Fax:354-528-5394
Practice Address - Street 1:133 N 100 W
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:UT
Practice Address - Zip Code:84643-0209
Practice Address - Country:US
Practice Address - Phone:209-669-2880
Practice Address - Fax:435-528-5394
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS127241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical