Provider Demographics
NPI:1285091348
Name:LARSON, ERIK HANS (LICSW, LPI)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:HANS
Last Name:LARSON
Suffix:
Gender:M
Credentials:LICSW, LPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 148TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-9252
Mailing Address - Country:US
Mailing Address - Phone:206-229-7984
Mailing Address - Fax:425-641-9223
Practice Address - Street 1:6947 COAL CREEK PKWY SE # 327
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3136
Practice Address - Country:US
Practice Address - Phone:206-229-7984
Practice Address - Fax:425-641-9223
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60338539101YM0800X, 1041C0700X, 171M00000X
WA60265039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4255686927Medicaid
WA4255686927Medicare NSC
WA4255686927Medicare PIN
WA4255686927Medicare Oscar/Certification
WA4255686927Medicare UPIN