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General NPI Number Information
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NPI Number | 1891167862
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Entity Type | Organization
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Legal Business Name | TANYA LARSON THERAPY
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 1102 A. ST., SUITE 109 (SUITE 109)
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City | TACOMA
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State | WA
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Zip | 98402
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Country | US
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Telephone | 253-686-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 A. ST., SUITE 109
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City | TACOMA
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State | WA
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Zip | 98402
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Country | US
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Telephone | 253-686-9421
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. TANYA MARIE LARSON
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Credential | MA,MHP,LMHCA
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Telephone | 253-686-9421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MC60489337
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License Number State | WA
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