Healthcare Provider Details

I. General information

NPI: 1073656906
Provider Name (Legal Business Name): KENT GARTH LARSON L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 SOUTH STATE STREET SUITE A
MIDVALE UT
84047-6105
US

IV. Provider business mailing address

7321 SOUTH STATE STREET SUITE A
MIDVALE UT
84047-6105
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-4327
  • Fax: 801-878-9280
Mailing address:
  • Phone: 801-878-4327
  • Fax: 801-878-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number279663-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: