Basic Information
| Provider Information | |||||||||
| NPI: | 1154495984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSEN | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | GAYLE | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9919 58TH ST NW | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983355904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534411714 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4807 196TH ST SW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980366430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257744269 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | RC00046822 | WA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.