Basic Information
| Provider Information | |||||||||
| NPI: | 1083852305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARZELIER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | DOUG | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | TILLAMOOK | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971413816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038428201 | ||||||||
| FaxNumber: | 5038151870 | ||||||||
| Practice Location | |||||||||
| Address1: | 906 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | TILLAMOOK | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971413618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038428201 | ||||||||
| FaxNumber: | 5038151870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2009 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW 60116543 | WA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | L5374 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.