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General NPI Number Information
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NPI Number | 1730636523
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Entity Type | Organization
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Legal Business Name | LISA RAYMOND LARSON
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Dates
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Enumeration Date | 09/08/2016
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Last Update Date | 09/08/2016
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Provider Practice Location Address
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Address Line | 120 E LIBERTY ST SUITE 320
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City | ANN ARBOR
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State | MI
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Zip | 48104-2156
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Country | US
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Telephone | 734-635-9365
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Fax | 734-661-4112
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Provider Business Mailing Address
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Address Line | 120 E LIBERTY ST SUITE 320
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City | ANN ARBOR
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State | MI
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Zip | 48104-2156
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Country | US
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Telephone | 734-635-9365
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Fax | 734-661-4112
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Authorized Official
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Title or Position | LICENSED SOCIAL WORKER
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Name | DR. LISA RAYMOND LARSON
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Credential | LMSW
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Telephone | 734-635-9365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801046960
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License Number State | MI
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