Provider Demographics
NPI:1699108845
Name:LARSON, TANYA MARIE (MA, MHP, LMHC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:MA, MHP, LMHC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1102 A ST STE 202C
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5005
Mailing Address - Country:US
Mailing Address - Phone:253-686-9421
Mailing Address - Fax:
Practice Address - Street 1:1102 A ST STE 202C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5005
Practice Address - Country:US
Practice Address - Phone:253-686-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
WALH60736169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health