Basic Information
Provider Information
NPI: 1437466752
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LARRIMER
FirstName: ANDREW
MiddleName: HUBBARD
NamePrefix:  
NameSuffix:  
Credential: MA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3401 EUDORA ST.
Address2:  
City: DENVER
State: CO
PostalCode: 80207
CountryCode: US
TelephoneNumber: 3033006333
FaxNumber:  
Practice Location
Address1: 3401 EUDORS ST.
Address2:  
City: DENVER
State: CO
PostalCode: 80207
CountryCode: US
TelephoneNumber: 3033006333
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/08/2010
LastUpdateDate: 02/26/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X0012557COY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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