Provider Demographics
NPI:1427116417
Name:LARSEN, LINDA ALENE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ALENE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 FLAJOLE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9239
Mailing Address - Country:US
Mailing Address - Phone:989-837-2681
Mailing Address - Fax:989-832-2132
Practice Address - Street 1:810 E ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-4505
Practice Address - Country:US
Practice Address - Phone:989-832-2122
Practice Address - Fax:989-832-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010591131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008931660OtherBLUECROSS BLUESHIELD OF M
MI0N15810Medicare ID - Type Unspecified