Provider Demographics
NPI:1730876855
Name:LARSON, JOSEPH RYAN (CADC-R)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RYAN
Last Name:LARSON
Suffix:
Gender:M
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6419
Mailing Address - Country:US
Mailing Address - Phone:541-753-3333
Mailing Address - Fax:541-754-3333
Practice Address - Street 1:530 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6419
Practice Address - Country:US
Practice Address - Phone:541-753-3333
Practice Address - Fax:541-754-3333
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-22-1734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional