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Keith David Larsen
Peer Specialist in Canon City, Colorado
NPI 1679092167

Keith David Larsen is a Peer Specialist based in Canon City, CO. Keith David Larsen practices in Canon City, CO. The NPI Number for Keith David Larsen is 1679092167 and holds a License No. (Colorado).

The current practice location address for Keith David Larsen is 3239 Independence Rd, Canon City, CO and can be reached out via phone at 719-275-7650. You can also correspond with Keith David Larsen through the mailing address at 3239 INDEPENDENCE RD, CANON CITY, CO - 81212-9380 (mailing address contact number: ).

Location: 3239 Independence Rd, Canon City, CO, 81212-9380
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679092167
Provider Name
Keith David Larsen
Credential
Provider Entity Type
Individual
Gender
Male
Address
3239 Independence Rd, Canon City, CO, 81212-9380
Phone Number
719-275-7650
Fax Number
Provider Enumeration Date
09/15/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
3239 Independence Rd
City
Canon City
State
Colorado
Zip
81212-9380
Phone Number
719-275-7650
Fax Number
person
Provider Business Mailing Address Details
Address
3239 Independence Rd
City
Canon City
State
Colorado
Zip
81212-9380
Phone Number
719-275-7650
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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