Healthcare Provider Details

I. General information

NPI: 1750975314
Provider Name (Legal Business Name): JEREMY LARSON LMFT, APCC, CSAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18122 CARMENITA RD UNIT 3643
CERRITOS CA
90703-5830
US

IV. Provider business mailing address

18122 CARMENITA RD UNIT 3643
CERRITOS CA
90703-5830
US

V. Phone/Fax

Practice location:
  • Phone: 562-232-9688
  • Fax:
Mailing address:
  • Phone: 562-232-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162616
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1420450221
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: