Provider Demographics
NPI:1740141985
Name:LARSON, BARRY JOSEPH
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:JOSEPH
Last Name:LARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 SUTTON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3917
Mailing Address - Country:US
Mailing Address - Phone:314-781-7900
Mailing Address - Fax:
Practice Address - Street 1:3155 SUTTON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3917
Practice Address - Country:US
Practice Address - Phone:314-704-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250450981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical