Healthcare Provider Details

I. General information

NPI: 1962367128
Provider Name (Legal Business Name): LARCH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 380TH AVE
GRINNELL IA
50112-8220
US

IV. Provider business mailing address

126 380TH AVE
GRINNELL IA
50112-8220
US

V. Phone/Fax

Practice location:
  • Phone: 309-361-5088
  • Fax:
Mailing address:
  • Phone: 309-361-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANN COLLINS
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 309-361-5088