Provider Demographics
NPI:1174075808
Name:LARSEN, PATRICIA LINNEA
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LINNEA
Last Name:LARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N 2ND ST UNIT 207
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3191
Mailing Address - Country:US
Mailing Address - Phone:865-455-9236
Mailing Address - Fax:
Practice Address - Street 1:2284 RALEIGH CT STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1945
Practice Address - Country:US
Practice Address - Phone:865-455-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-16-23367106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst