Provider Demographics
NPI:1831919497
Name:LARSEN, TAYLOR ROSE (MS)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ROSE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 WANDERLUST PT APT 211
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7062
Mailing Address - Country:US
Mailing Address - Phone:719-580-1103
Mailing Address - Fax:
Practice Address - Street 1:6710 S US HIGHWAY 85-87
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1014
Practice Address - Country:US
Practice Address - Phone:719-388-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling