Provider Demographics
NPI:1750013108
Name:LARSON, BRITTANY JO (LCSW)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:JO
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:MIRRASOUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21168 E OCOTILLO RD # 1009
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8175
Mailing Address - Country:US
Mailing Address - Phone:480-617-3912
Mailing Address - Fax:
Practice Address - Street 1:21168 E OCOTILLO RD # 1009
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-8175
Practice Address - Country:US
Practice Address - Phone:480-617-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-222881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical