Healthcare Provider Details

I. General information

NPI: 1881513166
Provider Name (Legal Business Name): MAIA LARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E BROADWAY STE 100
EUGENE OR
97401-3338
US

IV. Provider business mailing address

85060 SPENCER HOLLOW RD
EUGENE OR
97405-9519
US

V. Phone/Fax

Practice location:
  • Phone: 541-712-3011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: