Healthcare Provider Details

I. General information

NPI: 1184533077
Provider Name (Legal Business Name): MAUREEN KATHLEEN LARSON MFTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S CHERRY ST
DENVER CO
80246-2699
US

IV. Provider business mailing address

950 S CHERRY ST
DENVER CO
80246-2699
US

V. Phone/Fax

Practice location:
  • Phone: 630-200-1257
  • Fax:
Mailing address:
  • Phone: 630-200-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTC.0015040
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: