Basic Information
| Provider Information | |||||||||
| NPI: | 1467797126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSON | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E OLIVE ST | ||||||||
| Address2: | SOUND MENTAL HEALTH | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022200 | ||||||||
| FaxNumber: | 2063022210 | ||||||||
| Practice Location | |||||||||
| Address1: | 4238 AUBURN WAY N | ||||||||
| Address2: | SOUND MENTAL HEALTH | ||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980021311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538767600 | ||||||||
| FaxNumber: | 2538767650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CG60222068 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | CG60222068 | WA | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.