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NPI Code Detail

MEDICARE: TAYLOR ROSE LARSEN MS

MEDICARE: TAYLOR ROSE LARSEN MS
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
1103TC1900XCounseling Psychologist

General Provider Information

NPI Number : 1831919497
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAYLOR ROSE LARSEN MS
Provider Business Mailing Address
First Line : 1451 WANDERLUST PT APT 211
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-7062
Country : US
Telephone Number : 719-580-1103
Fax Number :
Provider Business Practice Location Address
First Line : 6710 S US HIGHWAY 85-87
Second Line :
City : FOUNTAIN
State : CO
Zip : 80817-1014
Country : US
Telephone Number : 719-388-3558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2024
Last Update Date : 10/16/2024

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