Healthcare Provider Details

I. General information

NPI: 1285325332
Provider Name (Legal Business Name): LARSEN ANGUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 E CAMELBACK RD STE 100
PHOENIX AZ
85016-4409
US

IV. Provider business mailing address

PO BOX 72772
PHOENIX AZ
85050-1030
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-5666
  • Fax:
Mailing address:
  • Phone: 480-999-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001842
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: