Basic Information
| Provider Information | |||||||||
| NPI: | 1043603855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | LARKIN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 ADDISON AVE W | ||||||||
| Address2: | STE. 103 | ||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833015851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087370572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7803 NE FOURTH PLAIN BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986627294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605664432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC-5803 | ID | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LH60707671 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.