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NPI Code Detail

MEDICARE: CRAIG ALAN LARSON LADC

MEDICARE: CRAIG ALAN LARSON LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor232NV

General Provider Information

NPI Number : 1013229129
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRAIG ALAN LARSON LADC
Provider Business Mailing Address
First Line : 304 HORSE POINTE AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-1224
Country : US
Telephone Number : 702-236-4484
Fax Number :
Provider Business Practice Location Address
First Line : 3900 W CHARLESTON BLVD STE 170
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1682
Country : US
Telephone Number : 702-453-4673
Fax Number : 702-453-2673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2010
Last Update Date : 07/06/2010

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Directions to “ CRAIG ALAN LARSON LADC” Practice Location

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