Provider Demographics
NPI:1841613072
Name:LARSON BRAUN, SARA J (LPA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:LARSON BRAUN
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:907-212-6531
Mailing Address - Fax:
Practice Address - Street 1:2250 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 202
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7412
Practice Address - Country:US
Practice Address - Phone:907-761-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPSYA420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional