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NPI Code Detail

MEDICARE: LARSEN SANCHEZ PSYCHOLOGY, LLC

MEDICARE: LARSEN SANCHEZ PSYCHOLOGY, LLC
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
1261QM0850XAdult Mental Health Clinic/Center
2163WP0808XPsychiatric/Mental Health Registered Nurse
3103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1588041388
Entity Type Code : Organization
Provider Name (Legal Business Name) : LARSEN SANCHEZ PSYCHOLOGY, LLC
Provider Business Mailing Address
First Line : 905 SE 14TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2569
Country : US
Telephone Number : 503-715-5468
Fax Number : 503-715-5469
Provider Business Practice Location Address
First Line : 905 SE 14TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2569
Country : US
Telephone Number : 503-622-8964
Fax Number :
Authorized Official
Title or Position : PSYCHOLOGIST/OWNER
Name : DR. BRAD LARSEN
Credential : PSYD
Telephone Number : 503-715-5468
Provider Enumeration Date : 04/30/2015
Last Update Date : 11/05/2023

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