Provider Demographics
NPI:1912479734
Name:LARSON, TIFFANY A (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 N 100 W APT 3
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2839
Mailing Address - Country:US
Mailing Address - Phone:435-669-1518
Mailing Address - Fax:
Practice Address - Street 1:344 SUNLAND DR STE 2A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2280
Practice Address - Country:US
Practice Address - Phone:435-669-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT861257435011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical