Provider Demographics
NPI:1487095410
Name:LARSON, JEAN A (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 ROBB ST
Mailing Address - Street 2:STE 201
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2162
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:888-341-5050
Practice Address - Street 1:2118 CHATALET LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-4625
Practice Address - Country:US
Practice Address - Phone:719-564-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical