Basic Information
| Provider Information | |||||||||
| NPI: | 1043860604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSGAARD | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | LEA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CDC 1, BHA 2 | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | REUER | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | LEA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1840 BRAGAW ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995083463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075624155 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1840 BRAGAW ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995083463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075624155 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2019 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 3915 | AK | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.