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General NPI Number Information
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NPI Number | 1184937484
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Entity Type | Individual
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Provider Name | JEFFREY KENT LARSEN M.A. MFT
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Gender | Male
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 2801 CAMINO DEL RIO S SUITE 202
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City | SAN DIEGO
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State | CA
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Zip | 92108-3800
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Country | US
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Telephone | 619-207-7005
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Fax | 619-271-3123
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Provider Business Mailing Address
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Address Line | 867 GOLD OAK CT
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City | CHULA VISTA
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State | CA
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Zip | 91910-6754
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Country | US
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Telephone | 619-207-7005
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Fax | 619-271-3123
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MFC45671
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MFC45671
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC45671
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License Number State | CA
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