=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609909985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA KAYE LARSON MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 DAVIDDEAN DR
-----------------------------------------------------
City | KALAMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98625-9417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-751-7213
-----------------------------------------------------
Fax | 360-673-2248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 892
-----------------------------------------------------
City | KALAMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98625-0800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-673-1799
-----------------------------------------------------
Fax | 360-673-2248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LH00011197
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------