Provider Demographics
NPI:1952017550
Name:LARSEN, OKSANA (LMSW)
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16826 AGATE LN
Mailing Address - Street 2:
Mailing Address - City:WILDER
Mailing Address - State:ID
Mailing Address - Zip Code:83676-5853
Mailing Address - Country:US
Mailing Address - Phone:208-447-7323
Mailing Address - Fax:
Practice Address - Street 1:1224 1ST ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3900
Practice Address - Country:US
Practice Address - Phone:208-936-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-43037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLMSW-43037OtherIDAHO STATE BOARD OF SOCIAL WORK EXAMINERS