John David Larsen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4959333-3501 Issued in UT

Practice address

75TH Medical Group
7321 Balmer Street Building 570
Hill AFB, UT 84056

Phone

(801) 777-3497

NPI assigned

Jan 7, 2009

Last updated

Dec 3, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Davis Behavioral Health Inc

  • Family Medicine Physician
  • Layton, UT
  • NPI 1144872516
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1013154442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75TH MEDICAL GROUP",
            "address_2": "7321 BALMER STREET BUILDING 570",
            "city": "HILL AFB",
            "state": "UT",
            "postal_code": "84056",
            "telephone_number": "801-777-3497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75TH MEDICAL GROUP",
            "address_2": "7321 BALMER STREET BUILDING 570",
            "city": "HILL AFB",
            "state": "UT",
            "postal_code": "84056",
            "telephone_number": "801-777-3497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-07",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "4959333-3501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870430116009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Anthony Huseman II, MD
• Kelly Johnson
• Vanessa Jones
• Daniel Jacob Kardouni, MA,LD,RD
• Eric Ford Kebker, PHD, ABPP
• Derek R Larson, LCSW
• Nathan Michael Leeman, IDMT-P
• Tracy Amy Louie
• Staci Lynne Maclean
• Chloe Marie Mager, PHYSICIAN ASSISTANT

• Clinical Social Worker in Hill AFB, UT
• Providers in Hill AFB, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.