Provider Demographics
NPI:1316650765
Name:LARSON, ANDREW (RBT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 LUNALILO ST APT 10
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3924
Mailing Address - Country:US
Mailing Address - Phone:512-970-3196
Mailing Address - Fax:
Practice Address - Street 1:550 KUNEHI ST APT 206
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2069
Practice Address - Country:US
Practice Address - Phone:808-674-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician