MEDICARE: BRETT CHRISTIAN LARSEN MA, LPCC-S

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
1	101YM0800X	Mental Health Counselor	E4323	OH
2	101YP2500X	Professional Counselor	E4323	OH

General Provider Information

NPI Number	:	1376667618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT CHRISTIAN LARSEN MA, LPCC-S

Provider Business Mailing Address
First Line	:	379 TERRACE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2051
Country	:	US
Telephone Number	:	513-476-5781
Fax Number	:	513-476-5781

Provider Business Practice Location Address
First Line	:	3416 CLIFTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1717
Country	:	US
Telephone Number	:	513-476-5781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	04/26/2019

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