Provider Demographics
NPI:1841882131
Name:LARSEN, MAKENZIE (CMHC)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 E 3665 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1115
Mailing Address - Country:US
Mailing Address - Phone:801-452-1653
Mailing Address - Fax:
Practice Address - Street 1:145 E 900 S STE 6
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-4241
Practice Address - Country:US
Practice Address - Phone:385-722-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12078515-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health