Provider Demographics
NPI:1154564318
Name:LARSON, VICTOR HARRY IV (MS)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:HARRY
Last Name:LARSON
Suffix:IV
Gender:M
Credentials:MS
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Mailing Address - Street 1:3707 E SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-7029
Mailing Address - Country:US
Mailing Address - Phone:559-229-9040
Mailing Address - Fax:559-229-9060
Practice Address - Street 1:3707 E SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-7029
Practice Address - Country:US
Practice Address - Phone:559-229-9040
Practice Address - Fax:559-229-9060
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2010-01-11
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)